Provider Demographics
NPI:1093269797
Name:CHOI, SOOL (PSY D,, RN)
Entity Type:Individual
Prefix:DR
First Name:SOOL
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:PSY D,, RN
Other - Prefix:DR
Other - First Name:BEATRICE SOOL
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D,, RN
Mailing Address - Street 1:2721 TROUSDALE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5754
Mailing Address - Country:US
Mailing Address - Phone:650-766-1929
Mailing Address - Fax:
Practice Address - Street 1:2721 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5754
Practice Address - Country:US
Practice Address - Phone:650-766-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical