Provider Demographics
NPI:1851607253
Name:JAE, HYEJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HYEJIN
Middle Name:
Last Name:JAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:JAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12675 LA MIRADA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2200
Mailing Address - Country:US
Mailing Address - Phone:562-903-7339
Mailing Address - Fax:562-944-8631
Practice Address - Street 1:12675 LA MIRADA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2200
Practice Address - Country:US
Practice Address - Phone:562-903-7339
Practice Address - Fax:562-944-8631
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine