Healthcare Provider Details

I. General information

NPI: 1588925408
Provider Name (Legal Business Name): CHRISTINE SUN-MI CHOI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10080 SW INNOVATION WAY STE 201
PORT ST LUCIE FL
34987-2129
US

IV. Provider business mailing address

10080 SW INNOVATION WAY STE 201
PORT ST LUCIE FL
34987-2129
US

V. Phone/Fax

Practice location:
  • Phone: 772-344-3811
  • Fax:
Mailing address:
  • Phone: 772-344-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME169256
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-21365
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: