Provider Demographics
NPI:1093397614
Name:HUR, CHRISTINE JAEIN (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JAEIN
Last Name:HUR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12531 HERITAGE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6914
Mailing Address - Country:US
Mailing Address - Phone:714-900-1609
Mailing Address - Fax:
Practice Address - Street 1:22015 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3355
Practice Address - Country:US
Practice Address - Phone:310-830-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35190-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist