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General NPI Number Information
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NPI Number | 1457884504
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Entity Type | Organization
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Legal Business Name | 64 BURNSIDE MEDICAL CONSULTING LLC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 70 THOROUGHBRED
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City | IRVINE
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State | CA
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Zip | 92602-1829
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Country | US
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Telephone | 201-207-6475
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Fax |
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Provider Business Mailing Address
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Address Line | 70 THOROUGHBRED
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City | IRVINE
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State | CA
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Zip | 92602-1829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CONSULTANT
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Name | PAUL CHOI
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Credential | M.D.
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Telephone | 201-207-6475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A119603
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License Number State | CA
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