Provider Demographics
NPI:1124189501
Name:CHOI, HEE JONG L (LAC)
Entity Type:Individual
Prefix:
First Name:HEE JONG
Middle Name:L
Last Name:CHOI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9900 BALBOA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5403
Mailing Address - Country:US
Mailing Address - Phone:818-701-0017
Mailing Address - Fax:818-701-0073
Practice Address - Street 1:9900 BALBOA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5403
Practice Address - Country:US
Practice Address - Phone:818-701-0017
Practice Address - Fax:818-701-0073
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7572171100000X
CAPA20193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC7572OtherCA LICENSED ACUPUNCTURIST