=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710054119
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID CHOI WOMEN CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 N ORANGE GROVE #203
-----------------------------------------------------
City | POMMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91787-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-620-1976
-----------------------------------------------------
Fax | 909-622-4590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1818 N ORANGE GROVE #203
-----------------------------------------------------
City | POMMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91787-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-620-1976
-----------------------------------------------------
Fax | 909-622-4590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID GONGWOOK CHOI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-620-1976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A36731
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------