Provider Demographics
NPI:1376194423
Name:CHOI, MIN
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CHICHIRICA ST UNIT 604
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4248
Mailing Address - Country:US
Mailing Address - Phone:918-998-2939
Mailing Address - Fax:
Practice Address - Street 1:136 KAYEN CHANDO
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5900
Practice Address - Country:US
Practice Address - Phone:671-632-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24570183500000X
GUPH0343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist