Provider Demographics
NPI:1275634248
Name:HWU, JIM-JER (MD)
Entity Type:Individual
Prefix:
First Name:JIM-JER
Middle Name:
Last Name:HWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1709
Mailing Address - Country:US
Mailing Address - Phone:626-280-0676
Mailing Address - Fax:626-280-2694
Practice Address - Street 1:120 E EMERSON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-1709
Practice Address - Country:US
Practice Address - Phone:626-280-0676
Practice Address - Fax:626-280-2694
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41098207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A410980Medicaid
CAE50600Medicare UPIN
CA00A410980Medicaid