Healthcare Provider Details

I. General information

NPI: 1356446090
Provider Name (Legal Business Name): FAMILY HEALTH CENTER PEDIATRICS AND FAMILY PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N CAUSEWAY
NEW SMYRNA BEACH FL
32169
US

IV. Provider business mailing address

245 N CAUSEWAY
NEW SMYRNA BEACH FL
32169
US

V. Phone/Fax

Practice location:
  • Phone: 386-426-5800
  • Fax: 386-426-1416
Mailing address:
  • Phone: 386-426-5800
  • Fax: 386-426-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAE SUNG CHOI
Title or Position: PRESIDENT
Credential: MD
Phone: 386-426-5800