Provider Demographics
NPI:1740533728
Name:CHOI, JAEWOOK
Entity type:Individual
Prefix:
First Name:JAEWOOK
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 BELL BLVD
Mailing Address - Street 2:106
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1645
Mailing Address - Country:US
Mailing Address - Phone:347-256-1455
Mailing Address - Fax:
Practice Address - Street 1:1670 BELL BLVD
Practice Address - Street 2:106
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1645
Practice Address - Country:US
Practice Address - Phone:347-256-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
031918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist