Healthcare Provider Details

I. General information

NPI: 1508429663
Provider Name (Legal Business Name): ANDREW YOUNG CHOI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 170264
BROOKLYN NY
11217-0264
US

IV. Provider business mailing address

PO BOX 170264
BROOKLYN NY
11217-0264
US

V. Phone/Fax

Practice location:
  • Phone: 213-293-0583
  • Fax:
Mailing address:
  • Phone: 213-293-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number33136
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1916
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number026945
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: