Provider Demographics
NPI:1356627129
Name:OCEAN VALLEY IMAGING LLC
Entity Type:Organization
Organization Name:OCEAN VALLEY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-831-8826
Mailing Address - Street 1:2 MAREBLU
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3035
Mailing Address - Country:US
Mailing Address - Phone:949-831-8826
Mailing Address - Fax:949-831-8592
Practice Address - Street 1:2 MAREBLU
Practice Address - Street 2:SUITE 200
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3035
Practice Address - Country:US
Practice Address - Phone:949-831-8826
Practice Address - Fax:949-831-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37370261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherIRS