Healthcare Provider Details

I. General information

NPI: 1407484058
Provider Name (Legal Business Name): DA SOM CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 SCENIC DR
MODESTO CA
95350-6137
US

IV. Provider business mailing address

3249 SHRUTE DR
LATHROP CA
95330-8131
US

V. Phone/Fax

Practice location:
  • Phone: 209-442-6077
  • Fax:
Mailing address:
  • Phone: 334-672-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016104
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1-154049
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95231909
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-154049
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: