Organization
JI SON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA LONG (CREDENTIALING)
(501) 223-2776
Entity
Organization
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 268-7009
Mailing address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 268-7009
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
07/25/2022
Last updated
07/27/2022
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