MEDICARE: LAURA LONWAH JIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95018601	CA

General Provider Information

NPI Number	:	1588302665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LONWAH JIN

Provider Business Mailing Address
First Line	:	16518 MURPHY RD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-6218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4161 REDONDO BEACH BLVD STE 100
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3340
Country	:	US
Telephone Number	:	310-214-1407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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Directions to “ LAURA LONWAH JIN ” Practice Location

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