Provider Demographics
NPI:1235244534
Name:CHOA, AGNES LEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:LEE
Last Name:CHOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Mailing Address - Country:US
Mailing Address - Phone:626-810-2895
Mailing Address - Fax:626-913-2785
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
Practice Address - Country:US
Practice Address - Phone:213-637-2539
Practice Address - Fax:626-913-2785
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37974207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A379746Medicaid
CA00A379746Medicaid
A37974Medicare PIN