Provider Demographics
NPI:1255405635
Name:CHOI, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
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 1:2019 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-7415
Mailing Address - Country:US
Mailing Address - Phone:877-358-5841
Mailing Address - Fax:323-694-2543
Practice Address - Street 1:2019 SATURN ST
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-7415
Practice Address - Country:US
Practice Address - Phone:877-358-5841
Practice Address - Fax:323-694-2543
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A425700Medicaid
CA00A425700Medicaid
CAWA42570AMedicare PIN