Provider Demographics
NPI:1063826691
Name:CHOE, JAE SUNG (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:JAE
Middle Name:SUNG
Last Name:CHOE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 E THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3639
Mailing Address - Country:US
Mailing Address - Phone:805-497-3614
Mailing Address - Fax:805-497-0524
Practice Address - Street 1:3825 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3639
Practice Address - Country:US
Practice Address - Phone:805-497-3614
Practice Address - Fax:805-497-0524
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist