DONGWHAN DUSTIN IM PHYSICIAN ASSISTANT
NPI 1174257414
Physician Assistant in Fullerton, CA
About Dongwhan Dustin Im Physician Assistant NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DONGWHAN DUSTIN IM PHYSICIAN ASSISTANT (NPI 1174257414) is an individual physician assistant in Fullerton, California and active in the NPI registry since July 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Tustin, and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dongwhan Dustin Im Physician Assistant is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92835 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FULLERTON, CA 92835
FULLERTON, CA 92835
FULLERTON, CA 92835
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dongwhan Im's NPI number?
The NPI number for Dongwhan Im is 1174257414. It was assigned to this individual provider in the NPPES registry on July 12, 2022.
Where is Dongwhan Im located?
Dongwhan Im practices at 1950 Sunny Crest Dr Ste 2600, Fullerton, CA 92835. The listed phone number is (714) 446-5590.
What is Dongwhan Im's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Dongwhan Im enrolled in Medicare?
Yes. Dongwhan Im is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Dongwhan Im was last updated on June 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dongwhan Dustin Im, PHYSICIAN ASSISTANT · NPI 1174257414
Physician Assistant physician in Fullerton, California. Individual provider, active in the CMS NPPES registry since July 12, 2022.
## Identity
- **NPI:** 1174257414 (Entity type: Individual)
- **Enumerated:** July 12, 2022
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1950 SUNNY CREST DR STE 2600, Fullerton, CA 92835-3644
- **Phone:** (714) 446-5590 · **Fax:** (714) 446-5592
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** June 18, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1174257414) · Data from the CMS NPPES public registry.