Provider Demographics
NPI:1477559532
Name:CHOE, SOO-SANG (MD)
Entity Type:Individual
Prefix:DR
First Name:SOO-SANG
Middle Name:
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 1:903 E DEVONSHIRE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3097
Mailing Address - Country:US
Mailing Address - Phone:951-925-0571
Mailing Address - Fax:951-766-4428
Practice Address - Street 1:903 E DEVONSHIRE AVE
Practice Address - Street 2:STE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3097
Practice Address - Country:US
Practice Address - Phone:951-925-0571
Practice Address - Fax:951-766-4428
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2014-01-22
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
CAA26455174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A264550Medicare ID - Type Unspecified
CAA24843Medicare UPIN