Healthcare Provider Details

I. General information

NPI: 1104566769
Provider Name (Legal Business Name): EUN JUNG HILAIRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EUN JUNG HILAIRE MD

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTH STATE STREET CLINIC TOWER, SUITE A7D
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

5516 SCOTWOOD DR
RANCHO PALOS VERDES CA
90275-4913
US

V. Phone/Fax

Practice location:
  • Phone: 310-713-5731
  • Fax:
Mailing address:
  • Phone: 310-713-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA188799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: