Healthcare Provider Details

I. General information

NPI: 1730636226
Provider Name (Legal Business Name): JENNIFER CHOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE #570
ORANGE CA
92868-4300
US

IV. Provider business mailing address

3040 LA PAZ LN UNIT A
DIAMOND BAR CA
91765-3871
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-7700
  • Fax:
Mailing address:
  • Phone: 909-367-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95003998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: