Healthcare Provider Details

I. General information

NPI: 1417034257
Provider Name (Legal Business Name): SUNG SUB CHOI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN SUNGSUB CHOI MD

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 W OLYMPIC BLVD STE 210
LOS ANGELES CA
90019
US

IV. Provider business mailing address

3323 W OLYMPIC BLVD STE 210
LOS ANGELES CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 323-733-0127
  • Fax: 323-733-0990
Mailing address:
  • Phone: 323-733-0127
  • Fax: 323-733-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: