Individual provider Active NPI

Jenny S. Choi, O.D.

  • Optometrist
  • Costa Mesa, CA
National Provider Identifier
1356390538
Registry record updated Jan 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11301T Issued in CA
Practice address
3033 Bristol St
Suite E
Costa Mesa, CA 92626-3001
Phone
(714) 957-2704
Fax
(714) 557-4492
NPI assigned
May 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11301T CA Primary

Addresses

Primary practice location

3033 Bristol St
Suite E
Costa Mesa, CA 92626-3001

Mailing address

3033 Bristol St
Suite E
Costa Mesa, CA 92626-3001

Other identifiers 1

IdentifierTypeStateIssuer
WOP11301BOtherCAPPIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050525000504 CA Practitioner - Optometry 1951394105

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 1999
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3930 S Bristol St
Suite 207
Santa Ana, CA 92704-7431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11301CAMDSocial Worker
11301TCAMDOptometrist

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199491200000",
    "number": "1356390538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 BRISTOL ST",
            "address_2": "SUITE E",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 BRISTOL ST",
            "address_2": "SUITE E",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263001",
            "telephone_number": "714-957-2704",
            "fax_number": "714-557-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOI",
        "first_name": "JENNY",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2008-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11301T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN",
            "identifier": "WOP11301B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.