Provider Demographics
NPI:1457437410
Name:CHOI, SONGHOO KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:SONGHOO
Middle Name:KENT
Last Name:CHOI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ALLBROOK CT
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0245
Mailing Address - Country:US
Mailing Address - Phone:714-606-5330
Mailing Address - Fax:
Practice Address - Street 1:11911 ARTESIA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-4065
Practice Address - Country:US
Practice Address - Phone:562-809-3112
Practice Address - Fax:562-809-3139
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88663Medicare UPIN