Provider Demographics
NPI:1952128191
Name:CHOI, KWANGYEOL (LAC)
Entity type:Individual
Prefix:
First Name:KWANGYEOL
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S REYNOLDS ST APT 504
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4419
Mailing Address - Country:US
Mailing Address - Phone:443-207-3448
Mailing Address - Fax:
Practice Address - Street 1:8415 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4425
Practice Address - Country:US
Practice Address - Phone:443-207-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU03044OtherLICENSE NUMBER