Healthcare Provider Details

I. General information

NPI: 1215460001
Provider Name (Legal Business Name): HYEKYUNG THRANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 ORANGETHORPE AVE
BUENA PARK CA
90621-3341
US

IV. Provider business mailing address

26702 BRANDON
MISSION VIEJO CA
92692-4137
US

V. Phone/Fax

Practice location:
  • Phone: 714-503-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: