Provider Demographics
NPI:1306865688
Name:MA, JULIE MEYOUNG (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MEYOUNG
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15200 W SUNSET BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3620
Mailing Address - Country:US
Mailing Address - Phone:310-459-7736
Mailing Address - Fax:310-230-0284
Practice Address - Street 1:15200 W SUNSET BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3620
Practice Address - Country:US
Practice Address - Phone:310-459-7736
Practice Address - Fax:310-230-0284
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG84767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G751910Medicaid
CAF77912Medicare UPIN
CAWG75191AMedicare PIN
CA00G751910Medicaid