Provider Demographics
NPI:1760072961
Name:CHOI, JONGHYUN NICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:JONGHYUN
Middle Name:NICK
Last Name:CHOI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8923 LA RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2155
Mailing Address - Country:US
Mailing Address - Phone:201-341-2522
Mailing Address - Fax:
Practice Address - Street 1:8923 LA RIVIERA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2155
Practice Address - Country:US
Practice Address - Phone:201-341-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist