Provider Demographics
NPI:1689175275
Name:CHOI, MOON SUK (DR)
Entity Type:Individual
Prefix:
First Name:MOON SUK
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1619
Mailing Address - Country:US
Mailing Address - Phone:334-593-7544
Mailing Address - Fax:334-593-8588
Practice Address - Street 1:1759 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1619
Practice Address - Country:US
Practice Address - Phone:334-593-7544
Practice Address - Fax:334-593-8588
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110003171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALNAOtherNA