Provider Demographics
NPI:1881931616
Name:CHOI, CHANG SOON
Entity type:Individual
Prefix:
First Name:CHANG
Middle Name:SOON
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 W 8TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2991
Mailing Address - Country:US
Mailing Address - Phone:323-775-2344
Mailing Address - Fax:213-559-8909
Practice Address - Street 1:3550 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2991
Practice Address - Country:US
Practice Address - Phone:323-775-2344
Practice Address - Fax:213-559-8909
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist