MEDICARE: DR. BONG JOON 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
1	174400000X	Specialist	4301035612	MI

General Provider Information

NPI Number	:	1487058087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONG JOON CHOI M.D.

Provider Business Mailing Address
First Line	:	PSC 450 BOX 743
Second Line	:
City	:	APO
State	:	AP
Zip	:	96206-0009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 450 BOX 743
Second Line	:
City	:	APO
State	:	AP
Zip	:	96206-0009
Country	:	US
Telephone Number	:	82234100200
Fax Number	:	82234100231

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

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

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