Provider Demographics
NPI:1215233143
Name:CHOI, BYUNG SU
Entity type:Individual
Prefix:
First Name:BYUNG
Middle Name:SU
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:BYUNGSU
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3216 MARY ANN ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2640
Mailing Address - Country:US
Mailing Address - Phone:818-542-4005
Mailing Address - Fax:
Practice Address - Street 1:3216 MARY ANN ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2640
Practice Address - Country:US
Practice Address - Phone:818-542-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6479171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist