Provider Demographics
NPI:1619633872
Name:CHOI, HYESEONG
Entity Type:Individual
Prefix:
First Name:HYESEONG
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 W 207TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6411
Mailing Address - Country:US
Mailing Address - Phone:323-273-7566
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2715
Practice Address - Country:US
Practice Address - Phone:626-333-3172
Practice Address - Fax:626-333-3163
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301030261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA301030OtherPHYSICAL THERAPY BOARD OF CALIFORNIA