Provider Demographics
NPI:1740440262
Name:CHOI, BRYAN YOONSOK (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:YOONSOK
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 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-854-2504
Practice Address - Fax:041-854-2519
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01348207P00000X
DEC1-0013708207P00000X
RIMD13974207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093075AMedicaid
RI08/21/12OtherTUFTS HEALTH PLAN
RI08/24/12OtherHEALTHNET FED SERVICES
RI09/13/2012OtherNHPRI
RIBC89597Medicaid
RI07/24/2012OtherBCBS
RI07/24/2012OtherBCBS