Provider Demographics
NPI:1780749127
Name:ANDREW K CHOI M D PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANDREW K CHOI M D PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-965-1717
Mailing Address - Street 1:4160 WILSHIRE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3567
Mailing Address - Country:US
Mailing Address - Phone:323-965-1717
Mailing Address - Fax:323-965-1855
Practice Address - Street 1:4160 WILSHIRE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3567
Practice Address - Country:US
Practice Address - Phone:323-965-1717
Practice Address - Fax:323-965-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41771207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41771Medicare ID - Type Unspecified
CAA85699Medicare UPIN