Healthcare Provider Details

I. General information

NPI: 1962974907
Provider Name (Legal Business Name): KYUNG MI CHOI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

IV. Provider business mailing address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-7667
  • Fax: 415-252-7512
Mailing address:
  • Phone: 415-565-7667
  • Fax: 415-252-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95010776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: