MEDICARE: MR. ALLEN CHOI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	111175	CA
2	101YM0800X	Mental Health Counselor	111175	CA

General Provider Information

NPI Number	:	1013692722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN CHOI LCSW

Provider Business Mailing Address
First Line	:	1844 SAN MIGUEL DR STE 306A
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-8610
Country	:	US
Telephone Number	:	510-823-9069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1844 SAN MIGUEL DR STE 306A
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-8610
Country	:	US
Telephone Number	:	510-823-9069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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