Provider Demographics
NPI:1376973735
Name:CHOI, CHANG SOOK (LAC)
Entity Type:Individual
Prefix:
First Name:CHANG
Middle Name:SOOK
Last Name:CHOI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30091-0536
Mailing Address - Country:US
Mailing Address - Phone:770-726-5038
Mailing Address - Fax:470-437-3250
Practice Address - Street 1:6011 WESTERN HILLS DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3483
Practice Address - Country:US
Practice Address - Phone:770-727-5038
Practice Address - Fax:470-437-3250
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist