Provider Demographics
NPI:1922841311
Name:PREMIERONE PLUS IDS
Entity type:Organization
Organization Name:PREMIERONE PLUS IDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-434-0999
Mailing Address - Street 1:6800 LINCOLN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620
Mailing Address - Country:US
Mailing Address - Phone:714-495-4392
Mailing Address - Fax:714-388-3354
Practice Address - Street 1:6800 LINCOLN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620
Practice Address - Country:US
Practice Address - Phone:714-495-4392
Practice Address - Fax:714-388-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization