Healthcare Provider Details

I. General information

NPI: 1124361803
Provider Name (Legal Business Name): JI HYE SON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

IV. Provider business mailing address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5439
  • Fax: 562-789-4443
Mailing address:
  • Phone: 562-789-5439
  • Fax: 562-789-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA159983
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA159983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: