Healthcare Provider Details

I. General information

NPI: 1154812246
Provider Name (Legal Business Name): MIN KYUNG CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W MAGNOLIA BLVD RM 10
BURBANK CA
91506-1811
US

IV. Provider business mailing address

1101 W MAGNOLIA BLVD RM 10
BURBANK CA
91506-1811
US

V. Phone/Fax

Practice location:
  • Phone: 818-557-4199
  • Fax: 818-295-2545
Mailing address:
  • Phone: 818-557-4199
  • Fax: 818-295-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95029026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: