Provider Demographics
NPI:1912178419
Name:CHOI, MYO S (L AC)
Entity Type:Individual
Prefix:DR
First Name:MYO
Middle Name:S
Last Name:CHOI
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1862
Mailing Address - Country:US
Mailing Address - Phone:818-541-9751
Mailing Address - Fax:818-541-9397
Practice Address - Street 1:3430 FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1862
Practice Address - Country:US
Practice Address - Phone:818-541-9751
Practice Address - Fax:818-541-9397
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0054230Medicaid