Provider Demographics
NPI:1306043005
Name:CHOI, JIWON (MA, CCC)
Entity Type:Individual
Prefix:MISS
First Name:JIWON
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 ASSOCIATED RD
Mailing Address - Street 2:APT B49
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3275
Mailing Address - Country:US
Mailing Address - Phone:714-674-4977
Mailing Address - Fax:
Practice Address - Street 1:2666 ASSOCIATED RD
Practice Address - Street 2:APT B49
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3275
Practice Address - Country:US
Practice Address - Phone:714-674-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist