Provider Demographics
NPI:1598860058
Name:CHOI-KIM, LYDIA WOO YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:WOO YOUNG
Last Name:CHOI-KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYDIA
Other - Middle Name:WOO YOUNG
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:313-576-8699
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRT1117208600000X
MI4301097512208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630722Medicare PIN