Provider Demographics
NPI:1821256090
Name:ADVANCED CENTER FOR UROLOGY INC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNGHWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-534-0744
Mailing Address - Street 1:12555 GARDEN GROVE BLVD
Mailing Address - Street 2:STE. 405
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1902
Mailing Address - Country:US
Mailing Address - Phone:714-534-0744
Mailing Address - Fax:714-534-0785
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:STE. 405
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1902
Practice Address - Country:US
Practice Address - Phone:714-534-0744
Practice Address - Fax:714-534-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADO8061OtherMEDICARE RAILROAD
BC014Medicare PIN