Healthcare Provider Details

I. General information

NPI: 1316281454
Provider Name (Legal Business Name): HEATHER MYUNG WON HYUN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-5586
  • Fax: 818-500-5587
Mailing address:
  • Phone: 818-500-5586
  • Fax: 818-500-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: