Provider Demographics
NPI:1558377986
Name:CHOI, DAE SUNG (MD)
Entity Type:Individual
Prefix:
First Name:DAE SUNG
Middle Name:
Last Name:CHOI
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 1:245 NORTH 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 NORTH 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09289Medicare ID - Type Unspecified