Healthcare Provider Details

I. General information

NPI: 1043023351
Provider Name (Legal Business Name): BUNG JOO CHOI PHYSICIAN ASSISTANT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8619 RESEDA BLVD STE 104
NORTHRIDGE CA
91324-4048
US

IV. Provider business mailing address

20556 W DEER GRASS CT
PORTER RANCH CA
91326-4990
US

V. Phone/Fax

Practice location:
  • Phone: 818-207-0600
  • Fax: 888-830-8393
Mailing address:
  • Phone: 404-433-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: BUNG JOO CHOI
Title or Position: CEO
Credential: PA
Phone: 404-433-3737