Healthcare Provider Details

I. General information

NPI: 1710081955
Provider Name (Legal Business Name): JIMMY CHOI PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE 116B
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

950 CAMPBELL AVE 116B
WEST HAVEN CT
06516-2770
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone: 203-932-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number016014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: