Provider Demographics
NPI:1730636226
Name:CHOE, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 LA PAZ LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3871
Mailing Address - Country:US
Mailing Address - Phone:909-367-0330
Mailing Address - Fax:
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:#570
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4300
Practice Address - Country:US
Practice Address - Phone:714-835-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003998363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology