Provider Demographics
NPI:1104679612
Name:CHOI, VINCENT (DPM)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 ARCHWOOD AVE RM 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2519
Mailing Address - Country:US
Mailing Address - Phone:612-242-1995
Mailing Address - Fax:
Practice Address - Street 1:184 IRVING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4478
Practice Address - Country:US
Practice Address - Phone:612-242-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program