Provider Demographics
NPI:1043404957
Name:CHOI, HYEONJU (LAC)
Entity Type:Individual
Prefix:
First Name:HYEONJU
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2359
Mailing Address - Country:US
Mailing Address - Phone:718-274-4200
Mailing Address - Fax:718-204-4933
Practice Address - Street 1:4301 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2359
Practice Address - Country:US
Practice Address - Phone:718-274-4200
Practice Address - Fax:718-204-4933
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3521OtherACUPUNCTURIST