Healthcare Provider Details

I. General information

NPI: 1699988741
Provider Name (Legal Business Name): SUSANNA S. CHOI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9397 CROWN CREST BOULEVARD SUITE #220
PARKER CO
80138
US

IV. Provider business mailing address

9397 CROWN CREST BOULEVARD SUITE #220
PARKER CO
80138
US

V. Phone/Fax

Practice location:
  • Phone: 303-721-1670
  • Fax: 303-721-8117
Mailing address:
  • Phone: 303-721-1670
  • Fax: 303-721-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number24190
License Number StateCO

VIII. Authorized Official

Name: MS. VALERIE WILSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 303-721-6314