Provider Demographics
NPI:1033573811
Name:CHOI, YOUNG SOON
Entity Type:Individual
Prefix:
First Name:YOUNG SOON
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22672 LAMBERT ST STE 616
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1613
Mailing Address - Country:US
Mailing Address - Phone:213-342-7039
Mailing Address - Fax:
Practice Address - Street 1:22672 LAMBERT ST STE 616
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1613
Practice Address - Country:US
Practice Address - Phone:213-342-7039
Practice Address - Fax:800-285-2176
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16758171100000X
CAAC 16758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist