Healthcare Provider Details

I. General information

NPI: 1992267504
Provider Name (Legal Business Name): MICHELLE PARK CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

757 WESTWOOD PLAZA, EMERGENCY MEDICINE
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5111
  • Fax:
Mailing address:
  • Phone: 310-794-0785
  • Fax: 310-794-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA182013
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: