Provider Demographics
NPI:1750309027
Name:CHOI, RANDY (PA)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:RANDY
Other - Middle Name:K
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 70574
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-7574
Mailing Address - Country:US
Mailing Address - Phone:626-375-9602
Mailing Address - Fax:626-657-2695
Practice Address - Street 1:1030 S GLENDALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2866
Practice Address - Country:US
Practice Address - Phone:626-375-9602
Practice Address - Fax:626-657-2695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15088OtherLICENCE