Healthcare Provider Details

I. General information

NPI: 1205983079
Provider Name (Legal Business Name): PORTIA S CHOI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MOUNT VERNON AVE
BAKERSFIELD CA
93306-3302
US

IV. Provider business mailing address

4109 CHARDONNAY DR
BAKERSFIELD CA
93306-1307
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-0461
  • Fax: 661-868-0225
Mailing address:
  • Phone: 661-868-0461
  • Fax: 661-868-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG28128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: