Healthcare Provider Details

I. General information

NPI: 1619633872
Provider Name (Legal Business Name): HYESEONG CHOI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 111
LONG BEACH CA
90806-2715
US

IV. Provider business mailing address

1539 W 207TH ST APT 4
TORRANCE CA
90501-6411
US

V. Phone/Fax

Practice location:
  • Phone: 626-333-3172
  • Fax: 626-333-3163
Mailing address:
  • Phone: 323-273-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number301030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: