Healthcare Provider Details

I. General information

NPI: 1124760335
Provider Name (Legal Business Name): MICHELLE JISOO WON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

850 W TOWN AND COUNTRY RD UNIT 311
ORANGE CA
92868-5649
US

V. Phone/Fax

Practice location:
  • Phone: 408-857-4226
  • Fax:
Mailing address:
  • Phone: 714-456-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA195131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: