Provider Demographics
NPI:1306088109
Name:PREMIER CHOICE MEDI
Entity type:Organization
Organization Name:PREMIER CHOICE MEDI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IL HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-365-6311
Mailing Address - Street 1:2260 W LINCOLN AVE APT J6
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6531
Mailing Address - Country:US
Mailing Address - Phone:310-365-6311
Mailing Address - Fax:714-898-2589
Practice Address - Street 1:2260 W LINCOLN AVE APT J6
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6531
Practice Address - Country:US
Practice Address - Phone:310-365-6311
Practice Address - Fax:714-898-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management