Provider Demographics
NPI:1538979711
Name:CHOE, JAE HWAN
Entity type:Individual
Prefix:
First Name:JAE HWAN
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8462 WHITAKER ST APT 20
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3152
Mailing Address - Country:US
Mailing Address - Phone:213-352-6900
Mailing Address - Fax:
Practice Address - Street 1:8462 WHITAKER ST APT 20
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3152
Practice Address - Country:US
Practice Address - Phone:213-352-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist