Healthcare Provider Details

I. General information

NPI: 1689070690
Provider Name (Legal Business Name): WONSICK CHOE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20627 GOLDEN SPRINGS DR STE 1B
WALNUT CA
91789-4815
US

IV. Provider business mailing address

PO BOX 32039
LOS ANGELES CA
90032-0039
US

V. Phone/Fax

Practice location:
  • Phone: 909-480-0200
  • Fax: 909-480-0201
Mailing address:
  • Phone: 323-517-1274
  • Fax: 323-612-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberC42362
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC42362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: