=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043238769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOSES HYUN, M.D INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 10/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 966 S WESTERN AVE STE 204
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-735-1300
-----------------------------------------------------
Fax | 323-735-6734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 S WESTERN AVE STE 204
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-735-1300
-----------------------------------------------------
Fax | 323-735-6734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, M.D.
-----------------------------------------------------
Name | MOSES HYUN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 323-735-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A40302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | A40302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A40302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------