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NPI Code Detail

MEDICARE: DR. JOHNNY JAEHWAN CHOI M.D.

MEDICARE: DR. JOHNNY JAEHWAN CHOI M.D.
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
1207R00000XInternal Medicine Physician222248MA
2207R00000XInternal Medicine PhysicianA97680CA

General Provider Information

NPI Number : 1376640714
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHNNY JAEHWAN CHOI M.D.
Provider Business Mailing Address
First Line : 12900 PARK PLAZA DR STE 150
Second Line :
City : CERRITOS
State : CA
Zip : 90703-9329
Country : US
Telephone Number : 562-977-4639
Fax Number : 562-741-4479
Provider Business Practice Location Address
First Line : 141 W FOOTHILL BLVD
Second Line :
City : UPLAND
State : CA
Zip : 91786-8705
Country : US
Telephone Number : 909-296-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 08/30/2019

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