Provider Demographics
NPI:1922359868
Name:CHOI, YOON JUNG
Entity Type:Individual
Prefix:
First Name:YOON JUNG
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4343 E SOLIERE AVE
Mailing Address - Street 2:UNIT 1052
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7943
Mailing Address - Country:US
Mailing Address - Phone:515-707-0226
Mailing Address - Fax:
Practice Address - Street 1:637 W ROUTE 66
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-2334
Practice Address - Country:US
Practice Address - Phone:928-635-5977
Practice Address - Fax:928-635-5984
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist