Provider Demographics
NPI:1821088162
Name:CHOI, SOON A (MD)
Entity Type:Individual
Prefix:
First Name:SOON
Middle Name:A
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 W 6TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3047
Mailing Address - Country:US
Mailing Address - Phone:213-388-1111
Mailing Address - Fax:213-637-4755
Practice Address - Street 1:2420 OWEN RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3417
Practice Address - Country:US
Practice Address - Phone:810-342-1000
Practice Address - Fax:810-342-1590
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC1676OtherMCARE
MI1102525771OtherBLUE CROSS BLUE SHIELD
MI110B510530OtherBLUE CARE NETWORK
MI3302883Medicaid
MAE49693OtherHEALTH NET FEDERAL
MI110B510530OtherBLUE CROSS POINT OF SERVI
MI110B510530OtherCOMMUNITY BLUE
MI204371OtherMCLAREN HEALTH PLAN
MI4464705OtherAETNA
MI8388337001OtherCIGNA
MI110134957OtherMETRAHEALTH
MI110B510530OtherBLUE CROSS BLUE SHIELD
MI204371OtherHEALTH ADVANTAGE NETWORK
MIE49693OtherHEALTH ALLIANCE PLAN
MIE49693Medicare UPIN
MI0M28450007Medicare ID - Type Unspecified
MI110B510530OtherBLUE CROSS BLUE SHIELD
MI0M28450Medicare UPIN