=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306807763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOON JA CHOI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 SOUTH 631 ROUTE 59 SUITE E
-----------------------------------------------------
City | WARRENVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-393-3400
-----------------------------------------------------
Fax | 630-393-7589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 SOUTH 631 ROUTE 59 SUITE E
-----------------------------------------------------
City | WARRENVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-393-3400
-----------------------------------------------------
Fax | 630-393-7589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------