Healthcare Provider Details

I. General information

NPI: 1114324308
Provider Name (Legal Business Name): MYONG SUN CHOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVALON DR UNIT 3306
WOOD RIDGE NJ
07075-1024
US

IV. Provider business mailing address

300 AVALON DR UNIT 3306
WOOD RIDGE NJ
07075-1024
US

V. Phone/Fax

Practice location:
  • Phone: 617-512-4571
  • Fax:
Mailing address:
  • Phone: 617-512-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: