Healthcare Provider Details

I. General information

NPI: 1790326403
Provider Name (Legal Business Name): MIRAN CHOI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
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 STE 196
BERKELEY CA
94705-2702
US

V. Phone/Fax

Practice location:
  • Phone: 510-684-6834
  • Fax: 510-849-1495
Mailing address:
  • Phone: 510-867-7425
  • Fax: 510-849-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRAN CHOI
Title or Position: PROVIDER
Credential: MD
Phone: 510-867-7425