Provider Demographics
NPI:1710693890
Name:CHOE, JUNG (ABOC)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 TRABUCO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3617
Mailing Address - Country:US
Mailing Address - Phone:949-932-0961
Mailing Address - Fax:
Practice Address - Street 1:4200 TRABUCO RD STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3617
Practice Address - Country:US
Practice Address - Phone:949-932-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175668156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician