Healthcare Provider Details

I. General information

NPI: 1871405480
Provider Name (Legal Business Name): IMPERIAL VALLEY SPECIALTY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

IV. Provider business mailing address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-7146
  • Fax: 760-352-7612
Mailing address:
  • Phone: 760-339-7146
  • Fax: 760-352-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SEUNG GWON
Title or Position: CHIEF ADMINSITRATOR
Credential: MD
Phone: 760-339-7146