Healthcare Provider Details

I. General information

NPI: 1780749127
Provider Name (Legal Business Name): ANDREW K CHOI M D PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 WILSHIRE BLVD FL 2
LOS ANGELES CA
90010-3567
US

IV. Provider business mailing address

4160 WILSHIRE BLVD FL 2
LOS ANGELES CA
90010-3567
US

V. Phone/Fax

Practice location:
  • Phone: 323-965-1717
  • Fax: 323-965-1855
Mailing address:
  • Phone: 323-965-1717
  • Fax: 323-965-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA41771
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW K CHOI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-965-1717