Provider Demographics
NPI:1902840382
Name:CHOI, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SW 155TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2590
Mailing Address - Country:US
Mailing Address - Phone:206-453-4215
Mailing Address - Fax:206-453-4234
Practice Address - Street 1:322 SW 155TH ST STE C
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2590
Practice Address - Country:US
Practice Address - Phone:206-453-4215
Practice Address - Fax:206-453-4234
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG89211Medicare UPIN