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General NPI Number Information
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NPI Number | 1265034839
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Entity Type | Organization
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Legal Business Name | JIWON HELEN WYMAN MD PC
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 2372 MORSE AVE
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City | IRVINE
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State | CA
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Zip | 92614-6234
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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 |
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Authorized Official
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Title or Position | CEO
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Name | DR. JIWON HELEN WYMAN
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Credential | MD
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Telephone | 714-410-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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