Provider Demographics
NPI:1124593702
Name:CHOI, KATIE SEO YOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SEO YOUNG
Last Name:CHOI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 BEACH BLVD STE 110-523
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1250
Mailing Address - Country:US
Mailing Address - Phone:213-327-5480
Mailing Address - Fax:
Practice Address - Street 1:735 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2571
Practice Address - Country:US
Practice Address - Phone:213-330-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist