Provider Demographics
NPI:1447278031
Name:CHOI, YOUNG (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YOUNG
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1300 W 155TH ST
Mailing Address - Street 2:#206
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4048
Mailing Address - Country:US
Mailing Address - Phone:310-532-9943
Mailing Address - Fax:310-532-2094
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:#206
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4048
Practice Address - Country:US
Practice Address - Phone:310-532-9943
Practice Address - Fax:310-532-2094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A327620Medicaid
CA000A327620Medicaid
B50208Medicare UPIN