Healthcare Provider Details

I. General information

NPI: 1114330727
Provider Name (Legal Business Name): JIN CHOI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAND CREEK RD STE B
BRENTWOOD CA
94513-2540
US

IV. Provider business mailing address

PO BOX 31396
WALNUT CREEK CA
94598-8396
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-8585
  • Fax: 925-933-2709
Mailing address:
  • Phone: 925-939-8585
  • Fax: 925-933-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number14735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: