Healthcare Provider Details

I. General information

NPI: 1508008723
Provider Name (Legal Business Name): BONNIE K CHOI C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE KIM CRNP

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BOULEVARD 5TH FLOOR
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

34TH STREET AND CIVIC CENTER BOULEVARD WOOD BUILDING, 1ST FLOOR
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3440
  • Fax:
Mailing address:
  • Phone: 215-590-3440
  • Fax: 215-590-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN533464
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP010106
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: