Healthcare Provider Details

I. General information

NPI: 1386483337
Provider Name (Legal Business Name): KAYLA CHOI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA CHAN

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RIVERS EDGE RD
NEW YORK NY
10035-1163
US

IV. Provider business mailing address

4500 PARSONS BLVD
FLUSHING NY
11355-2205
US

V. Phone/Fax

Practice location:
  • Phone: 646-766-4000
  • Fax:
Mailing address:
  • Phone: 718-670-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number409016
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number820710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: