Provider Demographics
NPI:1093785388
Name:CHOO, NAMNIM (DC)
Entity Type:Individual
Prefix:DR
First Name:NAMNIM
Middle Name:
Last Name:CHOO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MEMORIAL DR
Mailing Address - Street 2:#1308
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4909
Mailing Address - Country:US
Mailing Address - Phone:617-577-5821
Mailing Address - Fax:617-577-5821
Practice Address - Street 1:1718 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1804
Practice Address - Country:US
Practice Address - Phone:617-492-5438
Practice Address - Fax:617-868-4611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2913111N00000X
MA264426163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV06760Medicare UPIN
MACHY45810Medicare ID - Type Unspecified