Provider Demographics
NPI:1245308238
Name:CHOI, HICHANG J (MD)
Entity type:Individual
Prefix:
First Name:HICHANG
Middle Name:J
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4336 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3564
Mailing Address - Country:US
Mailing Address - Phone:562-799-6000
Mailing Address - Fax:562-799-6001
Practice Address - Street 1:4336 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3564
Practice Address - Country:US
Practice Address - Phone:562-799-6000
Practice Address - Fax:562-799-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A754900Medicaid
CAW19291Medicare PIN
CA00A754900Medicaid