Provider Demographics
NPI:1932126745
Name:THOMAS B CHOI MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS B CHOI MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BOO-HUN
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-622-3937
Mailing Address - Street 1:11480 BROOKSHIRE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5023
Mailing Address - Country:US
Mailing Address - Phone:562-622-3937
Mailing Address - Fax:562-622-0040
Practice Address - Street 1:11480 BROOKSHIRE AVE STE 205
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5023
Practice Address - Country:US
Practice Address - Phone:562-622-3937
Practice Address - Fax:562-622-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69677207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G696770Medicaid
CAG69677DMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
CAF26698Medicare UPIN