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

Provider Other Name: ANDY CHOI PHD

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 124TH ST PO BOX 29
NEW YORK NY
10035-0029
US

IV. Provider business mailing address

118 E 124TH ST PO BOX 29
NEW YORK NY
10035-0029
US

V. Phone/Fax

Practice location:
  • Phone: 213-335-2282
  • Fax:
Mailing address:
  • Phone: 213-335-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY200001465
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1916
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number33136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: