=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053828590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JIMIN HWANG L.AC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2018
-----------------------------------------------------
Last Update Date | 11/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22481 EL TORO RD STE D
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-273-3294
-----------------------------------------------------
Fax | 949-522-9522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 OAKFIELD
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92620-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-872-8761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 16996
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------