Provider Demographics
NPI:1962673194
Name:CHOI, JEANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 LILLIAN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5645
Mailing Address - Country:US
Mailing Address - Phone:713-864-2229
Mailing Address - Fax:
Practice Address - Street 1:4108 LILLIAN ST
Practice Address - Street 2:UNIT B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5645
Practice Address - Country:US
Practice Address - Phone:832-721-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM86002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197227502OtherCSHCN
TX8AL159OtherBLUE CROSS BLUE SHIELD
TX197227501Medicaid
TX197227501Medicaid