Provider Demographics
NPI:1811798176
Name:CHOI, KI W
Entity type:Individual
Prefix:
First Name:KI
Middle Name:W
Last Name:CHOI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7466
Mailing Address - Country:US
Mailing Address - Phone:551-777-3336
Mailing Address - Fax:
Practice Address - Street 1:75 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7466
Practice Address - Country:US
Practice Address - Phone:551-777-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007706-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist