Healthcare Provider Details

I. General information

NPI: 1184565863
Provider Name (Legal Business Name): JI SON MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 E SANTA ANA CANYON RD UNIT 17852
ANAHEIM CA
92817-1241
US

IV. Provider business mailing address

5505 E SANTA ANA CANYON RD UNIT 17852
ANAHEIM CA
92817-1241
US

V. Phone/Fax

Practice location:
  • Phone: 951-268-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JI SON
Title or Position: CEO
Credential: MD
Phone: 949-394-2784