Provider Demographics
NPI:1053828590
Name:HWANG, JIMIN (LAC)
Entity Type:Individual
Prefix:
First Name:JIMIN
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OAKFIELD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2147
Mailing Address - Country:US
Mailing Address - Phone:949-872-8761
Mailing Address - Fax:
Practice Address - Street 1:22481 EL TORO RD STE D
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5052
Practice Address - Country:US
Practice Address - Phone:949-273-3294
Practice Address - Fax:949-522-9522
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist