MEDICARE: DR. JULIE HWYNN M.D.

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	207R00000X	Internal Medicine Physician	A66861	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780682401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE HWYNN M.D.

Provider Business Mailing Address
First Line	:	12555 GARDEN GROVE BLVD
Second Line	:	SUITE 301
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1902
Country	:	US
Telephone Number	:	714-741-0501
Fax Number	:	714-741-0095

Provider Business Practice Location Address
First Line	:	12555 GARDEN GROVE BLVD
Second Line	:	SUITE 301
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1902
Country	:	US
Telephone Number	:	714-741-0501
Fax Number	:	714-741-0095

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/18/2012

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