Provider Demographics
NPI:1740289719
Name:CHOI, SU JIN (MD)
Entity type:Individual
Prefix:DR
First Name:SU
Middle Name:JIN
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HIRST RD
Mailing Address - Street 2:#101
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6198
Mailing Address - Country:US
Mailing Address - Phone:540-338-4995
Mailing Address - Fax:540-338-2483
Practice Address - Street 1:205 HIRST RD
Practice Address - Street 2:#101
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6198
Practice Address - Country:US
Practice Address - Phone:540-338-4995
Practice Address - Fax:540-338-2483
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-10-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
VA0101225829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH41064Medicare UPIN
VAG01972S01Medicare ID - Type Unspecified