Provider Demographics
NPI:1760606156
Name:CHOI, SUSIE (LAC)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6511
Mailing Address - Country:US
Mailing Address - Phone:310-826-7597
Mailing Address - Fax:310-447-1864
Practice Address - Street 1:11633 SAN VICENTE BLVD.
Practice Address - Street 2:SUITE 220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-826-7597
Practice Address - Fax:310-447-1864
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist