Provider Demographics
NPI:1124361803
Name:SON, JI HYE (MD)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:HYE
Last Name:SON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12462 PUTNAM ST STE 501
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1049
Mailing Address - Country:US
Mailing Address - Phone:562-789-5439
Mailing Address - Fax:562-789-4443
Practice Address - Street 1:12462 PUTNAM ST STE 501
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1049
Practice Address - Country:US
Practice Address - Phone:562-789-5439
Practice Address - Fax:562-789-4443
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1599832086S0122X, 208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program