Provider Demographics
NPI:1871912279
Name:CHOI, MICHAEL BAHREN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BAHREN
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4211
Mailing Address - Country:US
Mailing Address - Phone:847-769-0567
Mailing Address - Fax:
Practice Address - Street 1:6102 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4211
Practice Address - Country:US
Practice Address - Phone:714-868-7733
Practice Address - Fax:213-556-1753
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292616207WX0120X
CAA171653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Single Specialty