Provider Demographics
NPI:1851049803
Name:CHOI, SOOWHAN (PHD)
Entity Type:Individual
Prefix:
First Name:SOOWHAN
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 DIAMOND CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4742
Mailing Address - Country:US
Mailing Address - Phone:816-501-6069
Mailing Address - Fax:
Practice Address - Street 1:7130 S 29TH ST STE G
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5841
Practice Address - Country:US
Practice Address - Phone:816-501-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist