Provider Demographics
NPI:1730654658
Name:LY, SUE CHOI
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:CHOI
Last Name:LY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39180 FARWELL DR STE 231
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1015
Mailing Address - Country:US
Mailing Address - Phone:510-585-2545
Mailing Address - Fax:
Practice Address - Street 1:39180 FARWELL DR STE 231
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1015
Practice Address - Country:US
Practice Address - Phone:510-585-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN685575163W00000X
CANP95009820363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse