Provider Demographics
NPI:1356446090
Name:FAMILY HEALTH CENTER PEDIATRICS AND FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER PEDIATRICS AND FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAE SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-426-5800
Mailing Address - Street 1:245 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169
Mailing Address - Country:US
Mailing Address - Phone:386-426-5800
Mailing Address - Fax:386-426-1416
Practice Address - Street 1:245 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169
Practice Address - Country:US
Practice Address - Phone:386-426-5800
Practice Address - Fax:386-426-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E34034Medicare UPIN
FL09289Medicare ID - Type Unspecified