Healthcare Provider Details

I. General information

NPI: 1023707619
Provider Name (Legal Business Name): JIYOUNG CHOI KIM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ROCKLAND ST
READING PA
19604-1501
US

IV. Provider business mailing address

645 PENN ST STE 301
READING PA
19601-3527
US

V. Phone/Fax

Practice location:
  • Phone: 610-988-4838
  • Fax:
Mailing address:
  • Phone: 610-988-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP027504
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP027504
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP027504
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: