Provider Demographics
NPI:1891929808
Name:CHOI, JONATHAN WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:WAYNE
Last Name:CHOI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1118
Mailing Address - Country:US
Mailing Address - Phone:832-721-3765
Mailing Address - Fax:
Practice Address - Street 1:464 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1118
Practice Address - Country:US
Practice Address - Phone:832-721-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005540363AM0700X
CAPA22748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical