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General NPI Number Information
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NPI Number | 1114934890
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Entity Type | Individual
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Provider Name | JUDY JISOO AEUM M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 20397 EARL ST
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City | TORRANCE
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State | CA
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Zip | 90503-7422
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Country | US
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Telephone | 808-476-4568
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 238032-1
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License Number State | NY
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