Healthcare Provider Details

I. General information

NPI: 1447549514
Provider Name (Legal Business Name): ANDREW CHOI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W VERDUGO AVE
BURBANK CA
91506-2101
US

IV. Provider business mailing address

2800 MONTROSE AVE APT 68
LA CRESCENTA CA
91214-3850
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-1141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25351
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: