Provider Demographics
NPI:1164733119
Name:AGNES L CHOA, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AGNES L CHOA, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-374-2538
Mailing Address - Street 1:1995 RIO BONITO DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4112
Mailing Address - Country:US
Mailing Address - Phone:213-637-2530
Mailing Address - Fax:213-384-3373
Practice Address - Street 1:2200 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4002
Practice Address - Country:US
Practice Address - Phone:213-637-2530
Practice Address - Fax:213-384-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3797A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty