Provider Demographics
NPI:1083827273
Name:RIM, CHOON SOO (MD)
Entity Type:Individual
Prefix:MR
First Name:CHOON
Middle Name:SOO
Last Name:RIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10583 HARVEST VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4192
Mailing Address - Country:US
Mailing Address - Phone:858-748-4401
Mailing Address - Fax:858-679-8745
Practice Address - Street 1:7920 FROST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2732
Practice Address - Country:US
Practice Address - Phone:858-248-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC508152084N0400X
MI43010320892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1061299Medicaid
MI1061299Medicaid
B44058Medicare UPIN