Healthcare Provider Details

I. General information

NPI: 1134285794
Provider Name (Legal Business Name): CHRISTINE HAE-JIN WON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE HAE-JIN CHI

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 N HARBOR BLVD SUITE 220
FULLERTON CA
92835
US

IV. Provider business mailing address

2720 N HARBOR BLVD STE 220
FULLERTON CA
92835-2626
US

V. Phone/Fax

Practice location:
  • Phone: 714-449-6990
  • Fax: 714-626-2682
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: