Healthcare Provider Details

I. General information

NPI: 1295338143
Provider Name (Legal Business Name): CHELSEA CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 508
ORANGE CA
92868-3856
US

IV. Provider business mailing address

1310 W STEWART DR STE 508
ORANGE CA
92868-3856
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: