Healthcare Provider Details

I. General information

NPI: 1598031460
Provider Name (Legal Business Name): DR. SEONG-IN CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SOUTH 300 WEST ASIAN ASSOCIATION OF UTAH
SALT LAKE CITY UT
84115-1217
US

IV. Provider business mailing address

1379 COBBLE CREEK RD 18K
SALT LAKE CITY UT
84117-6839
US

V. Phone/Fax

Practice location:
  • Phone: 801-467-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7752118-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: