Provider Demographics
NPI:1871648113
Name:JEUNG HO CHOI A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JEUNG HO CHOI A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT JEUNG HO CHOI A MEDICAL
Authorized Official - Prefix:
Authorized Official - First Name:JEUNG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-843-0653
Mailing Address - Street 1:2701 WEST ALAMEDA AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4408
Mailing Address - Country:US
Mailing Address - Phone:818-843-0653
Mailing Address - Fax:818-843-4492
Practice Address - Street 1:2701 WEST ALAMEDA AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4408
Practice Address - Country:US
Practice Address - Phone:818-843-0653
Practice Address - Fax:818-843-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29703261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A297032Medicaid
CA00A297032Medicaid
A29703BMedicare ID - Type Unspecified