Provider Demographics
NPI:1033214507
Name:CHOI, WHA JA (MD)
Entity Type:Individual
Prefix:
First Name:WHA JA
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DERICK DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1031
Mailing Address - Country:US
Mailing Address - Phone:845-896-8370
Mailing Address - Fax:
Practice Address - Street 1:841 ROUTE 52
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1516
Practice Address - Country:US
Practice Address - Phone:845-896-8370
Practice Address - Fax:845-896-8839
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05720Medicaid