Healthcare Provider Details

I. General information

NPI: 1083827273
Provider Name (Legal Business Name): CHOON SOO RIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 FROST ST SUITE 101
SAN DIEGO CA
92123-2732
US

IV. Provider business mailing address

10583 HARVEST VIEW WAY
SAN DIEGO CA
92128-4192
US

V. Phone/Fax

Practice location:
  • Phone: 858-248-6955
  • Fax:
Mailing address:
  • Phone: 858-748-4401
  • Fax: 858-679-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC50815
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301032089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: