Healthcare Provider Details

I. General information

NPI: 1619633872
Provider Name (Legal Business Name): HYESEONG CHOI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23430 HAWTHORNE BLVD STE 105
TORRANCE CA
90505-4777
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3812
  • Fax: 310-373-4686
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number301030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: