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General NPI Number Information
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NPI Number | 1043746621
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Entity Type | Individual
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Provider Name | JIWON HELEN WYMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 1918 BONITA AVE # 208
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City | BERKELEY
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State | CA
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Zip | 94704-1014
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Country | US
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Telephone | 714-410-6516
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Fax |
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Provider Business Mailing Address
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Address Line | 454 LAS GALLINAS AVE # 2030
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3618
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Country | US
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Telephone | 714-410-6516
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Fax | 714-274-7568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD61425994
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A159214
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD61425994
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A159214
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License Number State | CA
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