MEDICARE: MR. RANDY CHOI P.A.

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	363A00000X	Physician Assistant	15088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15088	OTHER	CA	LICENCE

General Provider Information

NPI Number	:	1750309027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY CHOI P.A.

Provider Business Mailing Address
First Line	:	PO BOX 70574
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91117-7574
Country	:	US
Telephone Number	:	626-375-9602
Fax Number	:	626-657-2695

Provider Business Practice Location Address
First Line	:	1030 S GLENDALE AVE STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2866
Country	:	US
Telephone Number	:	626-375-9602
Fax Number	:	626-657-2695

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/08/2012

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Directions to “ MR. RANDY CHOI P.A.” Practice Location

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