Healthcare Provider Details

I. General information

NPI: 1588905533
Provider Name (Legal Business Name): EDWIN CHOI MD EL MONTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 GARVEY AVE
EL MONTE CA
91732-3514
US

IV. Provider business mailing address

11920 GARVEY AVE
EL MONTE CA
91732-3514
US

V. Phone/Fax

Practice location:
  • Phone: 626-448-7575
  • Fax: 626-448-8831
Mailing address:
  • Phone: 626-448-7575
  • Fax: 626-448-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA54943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20832
License Number StateCA

VIII. Authorized Official

Name: EDWIN H CHOI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-448-7575