=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831231521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK E CHOI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 02/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4082 WHITTIER BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-265-0136
-----------------------------------------------------
Fax | 626-265-0166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4082 WHITTIER BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-265-0136
-----------------------------------------------------
Fax | 323-265-0166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A38076
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------