Provider Demographics
NPI:1801629597
Name:CHOI, ETHAN HYUNG
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:HYUNG
Last Name:CHOI
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 1:24171 JUANENO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4242
Mailing Address - Country:US
Mailing Address - Phone:949-633-5251
Mailing Address - Fax:
Practice Address - Street 1:24171 JUANENO DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4242
Practice Address - Country:US
Practice Address - Phone:949-633-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst