Provider Demographics
NPI:1306124037
Name:CHOE, MEERYO CHRISTA (MD)
Entity type:Individual
Prefix:
First Name:MEERYO
Middle Name:CHRISTA
Last Name:CHOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10405 INDEPENDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311
Mailing Address - Country:US
Mailing Address - Phone:818-516-5503
Mailing Address - Fax:
Practice Address - Street 1:UCLA DIVISION OF PEDIATRIC NEUROLOGY
Practice Address - Street 2:10833 LECONTE AVENUE, MDCC 22-474
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA960582084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A960580Medicaid
CA1306124037OtherMEDI CAL
CA1306124037OtherMEDI CAL