Healthcare Provider Details

I. General information

NPI: 1235353947
Provider Name (Legal Business Name): CHUN CHUNG CHOI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PEABODY HALL
GAINESVILLE FL
32611-4100
US

IV. Provider business mailing address

6315 NW 37TH DR
GAINESVILLE FL
32653-0856
US

V. Phone/Fax

Practice location:
  • Phone: 352-222-9354
  • Fax:
Mailing address:
  • Phone: 352-222-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY7443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: