Provider Demographics
NPI:1598200446
Name:CHOI, KELLY (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 MISSION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7994
Mailing Address - Country:US
Mailing Address - Phone:714-624-8447
Mailing Address - Fax:
Practice Address - Street 1:10380 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3727
Practice Address - Country:US
Practice Address - Phone:909-466-6020
Practice Address - Fax:909-466-1299
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA771769163W00000X
CA78171163W00000X
CA95005380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse