Healthcare Provider Details

I. General information

NPI: 1578707931
Provider Name (Legal Business Name): EDMUND HISUB CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20639 KUYKENDAHL RD STE 200
SPRING TX
77379-3587
US

IV. Provider business mailing address

375 ROLLING OAKS DR STE 210
THOUSAND OAKS CA
91361-1028
US

V. Phone/Fax

Practice location:
  • Phone: 832-698-0111
  • Fax: 832-698-0153
Mailing address:
  • Phone: 805-497-7015
  • Fax: 805-497-7315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberU5281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: