Healthcare Provider Details

I. General information

NPI: 1770644452
Provider Name (Legal Business Name): MIRAN CHOI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 ASHBY AVE
BERKELEY CA
94705-1909
US

IV. Provider business mailing address

2625 ALCATRAZ AVE # 196
BERKELEY CA
94705-2702
US

V. Phone/Fax

Practice location:
  • Phone: 510-684-6834
  • Fax: 510-849-1495
Mailing address:
  • Phone: 510-684-6834
  • Fax: 510-849-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA84621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: