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General NPI Number Information
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NPI Number | 1326263633
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Entity Type | Organization
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Legal Business Name | GARDEN GROVE PRIMARY CARE MEDICINE, INC.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 12555 GARDEN GROVE BLVD STE 301
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1903
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Country | US
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Telephone | 714-741-0501
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Fax | 714-741-0095
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Provider Business Mailing Address
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Address Line | 12555 GARDEN GROVE BLVD STE 301
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1903
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Country | US
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Telephone | 714-741-0501
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Fax | 714-741-0095
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE HWYNN
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Credential | M.D.
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Telephone | 714-741-0501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A66861
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License Number State | CA
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