Healthcare Provider Details

I. General information

NPI: 1689969164
Provider Name (Legal Business Name): JUNGWHAN JOHN CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115
US

IV. Provider business mailing address

3333 BURNET AVE # 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone: 513-636-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number278736
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number2766479
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35.143378
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: