Provider Demographics
NPI:1326041427
Name:CHOE, SUNG M (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:M
Last Name:CHOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E MERCED AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-918-1881
Mailing Address - Fax:626-918-3618
Practice Address - Street 1:421 E MERCED AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-918-1881
Practice Address - Fax:626-918-3618
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG604842088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G604840Medicaid
CAZZZ07538ZOtherBLUE SHIELD ID #
CA00G604841Medicaid
CA00G604841Medicaid
CA3608735Medicaid
CABC1014466OtherDEA NUMBER
CA00G604841Medicaid
CAE08434Medicare UPIN
CABC1014466OtherDEA NUMBER
CA00G604840Medicaid