Healthcare Provider Details

I. General information

NPI: 1831463082
Provider Name (Legal Business Name): WILLOW LINK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14795 JEFFREY RD SUITE 202
IRVINE CA
92618-0414
US

IV. Provider business mailing address

14795 JEFFREY RD SUITE 202
IRVINE CA
92618-0414
US

V. Phone/Fax

Practice location:
  • Phone: 949-398-7315
  • Fax: 949-398-7314
Mailing address:
  • Phone: 949-398-7315
  • Fax: 949-398-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7668
License Number StateCA

VIII. Authorized Official

Name: MR. GISANG RYU
Title or Position: OWNER
Credential: HIS
Phone: 949-398-7315