Healthcare Provider Details

I. General information

NPI: 1225228026
Provider Name (Legal Business Name): PETER SANGBEOM CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16635 N 43RD AVE
PHOENIX AZ
85053-2707
US

IV. Provider business mailing address

16635 N 43RD AVE
PHOENIX AZ
85053-2707
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-7900
  • Fax: 602-843-7903
Mailing address:
  • Phone: 602-843-7900
  • Fax: 602-843-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37275
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: