Provider Demographics
NPI:1457678948
Name:CHOI, CHANWON (LAC)
Entity Type:Individual
Prefix:
First Name:CHANWON
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26151 MARGUERITE PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5277
Mailing Address - Country:US
Mailing Address - Phone:626-388-3806
Mailing Address - Fax:
Practice Address - Street 1:26151 MARGUERITE PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5277
Practice Address - Country:US
Practice Address - Phone:626-388-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13290171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist