Healthcare Provider Details

I. General information

NPI: 1225379282
Provider Name (Legal Business Name): MS. KUMOK CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST
LOS ANGELES CA
90020-5105
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-1203
  • Fax:
Mailing address:
  • Phone: 718-918-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95004093
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number572215
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: