Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6435TG | TX |
NPI | 1003866096 |
---|---|
Provider Name | Jung H. Choi |
First Address | Friendswood, TX 77546-8937 |
Second Address | Friendswood, TX 77546-8937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1710543 | (05) | TX |
V00285 | (02) | TX |