Provider Demographics
NPI:1780682401
Name:HWYNN, JULIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:HWYNN
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 1:12555 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1902
Mailing Address - Country:US
Mailing Address - Phone:714-741-0501
Mailing Address - Fax:714-741-0095
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1902
Practice Address - Country:US
Practice Address - Phone:714-741-0501
Practice Address - Fax:714-741-0095
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A668610Medicaid
CA00A668610Medicaid
CAW17304Medicare ID - Type UnspecifiedGROUP MEDICARE #
CAWA66861AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #/PIN