Healthcare Provider Details

I. General information

NPI: 1649982331
Provider Name (Legal Business Name): JISOO MUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA STE 309
LAGUNA HILLS CA
92653-3144
US

IV. Provider business mailing address

105 FAIRHAVEN
IRVINE CA
92620-2174
US

V. Phone/Fax

Practice location:
  • Phone: 949-767-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA66549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: