Provider Demographics
NPI:1952584211
Name:CHOE, HAN TAE (OMD (ACUPUNCTURIST))
Entity Type:Individual
Prefix:DR
First Name:HAN TAE
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:OMD (ACUPUNCTURIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19745 COLIMA RD
Mailing Address - Street 2:SUITE 12 ( DR MIDAS MEDICAL GROUP )
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3219
Mailing Address - Country:US
Mailing Address - Phone:909-595-5550
Mailing Address - Fax:626-310-0520
Practice Address - Street 1:7488 LIME AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3173
Practice Address - Country:US
Practice Address - Phone:626-825-6846
Practice Address - Fax:909-356-5792
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist