Healthcare Provider Details

I. General information

NPI: 1962390583
Provider Name (Legal Business Name): INNOVATIVE MEDICAL SPECIALTIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 MARGARITA RD STE 101
TEMECULA CA
92592-2729
US

IV. Provider business mailing address

44045 MARGARITA RD STE 101
TEMECULA CA
92592-2729
US

V. Phone/Fax

Practice location:
  • Phone: 951-880-0701
  • Fax:
Mailing address:
  • Phone: 951-880-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JIN
Title or Position: PARTNER
Credential: MD
Phone: 951-880-0701