Provider Demographics
NPI:1578639076
Name:CHOI, MYUNG JA (MFC)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:JA
Last Name:CHOI
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 ARTESIA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2542
Mailing Address - Country:US
Mailing Address - Phone:562-860-8838
Mailing Address - Fax:562-860-0248
Practice Address - Street 1:11050 ARTESIA BLVD STE F
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2542
Practice Address - Country:US
Practice Address - Phone:562-860-8838
Practice Address - Fax:562-860-0248
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC43413OtherMFCC