Provider Demographics
NPI:1821259060
Name:SOO SANG CHOE MD A MEDICAL CORP
Entity Type:Organization
Organization Name:SOO SANG CHOE MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOO SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-925-0571
Mailing Address - Street 1:903 E DEVONSHIRE AVE
Mailing Address - Street 2:#A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-925-0571
Mailing Address - Fax:951-766-4428
Practice Address - Street 1:903 E DEVONSHIRE AVE
Practice Address - Street 2:#A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-925-0571
Practice Address - Fax:951-766-4428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOO SANG CHOE MD FACC GACP MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26455207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty