Healthcare Provider Details

I. General information

NPI: 1558117804
Provider Name (Legal Business Name): JOANNA DARLENE HAW YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA DARLENE SIMON HAW

II. Dates (important events)

Enumeration Date: 04/27/2024
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE STE 209
HEMET CA
92543-3083
US

IV. Provider business mailing address

1117 E DEVONSHIRE AVE STE 209
HEMET CA
92543-3083
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-3563
  • Fax:
Mailing address:
  • Phone: 714-953-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number16536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: