Provider Demographics
NPI:1205336559
Name:CHOI, EUN SUNG (NP)
Entity type:Individual
Prefix:
First Name:EUN SUNG
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2354
Mailing Address - Country:US
Mailing Address - Phone:718-205-6561
Mailing Address - Fax:718-205-4815
Practice Address - Street 1:3530 64TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2354
Practice Address - Country:US
Practice Address - Phone:718-205-6561
Practice Address - Fax:718-205-4815
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty