Healthcare Provider Details

I. General information

NPI: 1891550141
Provider Name (Legal Business Name): MICHAEL CHOI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 NW LOVEJOY ST STE 411
PORTLAND OR
97210-5102
US

IV. Provider business mailing address

94-1041 KAHUAMOKU ST APT 201
WAIPAHU HI
96797-3452
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-5702
  • Fax:
Mailing address:
  • Phone: 206-866-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA231061
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: