Provider Demographics
NPI:1245653260
Name:CHOE, CHANG (BCBA)
Entity type:Individual
Prefix:
First Name:CHANG
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17011 BEACH BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5998
Mailing Address - Country:US
Mailing Address - Phone:562-248-6377
Mailing Address - Fax:833-233-3050
Practice Address - Street 1:17011 BEACH BLVD STE 900
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5998
Practice Address - Country:US
Practice Address - Phone:562-248-6377
Practice Address - Fax:833-233-3050
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1.13.14520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst