Healthcare Provider Details

I. General information

NPI: 1386602720
Provider Name (Legal Business Name): BRIAN S. CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVENUE STE. #107
RIVERSIDE CA
92501
US

IV. Provider business mailing address

4500 BROCKTON AVE STE 107
RIVERSIDE CA
92501-4006
US

V. Phone/Fax

Practice location:
  • Phone: 951-276-2760
  • Fax: 951-276-2960
Mailing address:
  • Phone: 714-698-0300
  • Fax: 714-698-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA104454
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: