Provider Demographics
NPI:1013480011
Name:CHOI, JIN MO
Entity Type:Individual
Prefix:
First Name:JIN MO
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20531 S VERMONT AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1525
Mailing Address - Country:US
Mailing Address - Phone:323-823-3339
Mailing Address - Fax:
Practice Address - Street 1:1875 W REDONDO BEACH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3643
Practice Address - Country:US
Practice Address - Phone:323-823-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17964171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17964OtherCALIFORNIA BOARD OF ACUPUNCTURE