Provider Demographics
NPI:1356571517
Name:CHOE, ELLIE OKSONG (LAC)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:OKSONG
Last Name:CHOE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:OKSONG
Other - Middle Name:ELLIE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3930 RICHMOND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5103
Mailing Address - Country:US
Mailing Address - Phone:646-483-6564
Mailing Address - Fax:
Practice Address - Street 1:3930 RICHMOND AVE STE 200
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5103
Practice Address - Country:US
Practice Address - Phone:646-483-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00080700171100000X
NY3561171100000X
NY003561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist