Healthcare Provider Details

I. General information

NPI: 1861464513
Provider Name (Legal Business Name): CHONG HYUN CHOE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/05/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
OCEANSDIE CA
92055-5191
US

IV. Provider business mailing address

200 MERCY CIRCLE
OCEANSIDE CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3209
  • Fax:
Mailing address:
  • Phone: 760-719-3209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberD0060759
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD60276697
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberC182736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: