Provider Demographics
NPI:1669947305
Name:CHOI, SERENA SARAH
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:SARAH
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 N ALVERNON WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 N ALVERNON WAY STE 204
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1825
Practice Address - Country:US
Practice Address - Phone:520-626-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2023-08-04
Deactivation Date:2020-05-24
Deactivation Code:
Reactivation Date:2023-07-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZR80183207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program