Provider Demographics
NPI:1306807763
Name:CHOI, SOON JA (MD)
Entity type:Individual
Prefix:DR
First Name:SOON JA
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SOON JA
Other - Middle Name:
Other - Last Name:CHOI KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2 SOUTH 631 ROUTE 59
Mailing Address - Street 2:SUITE E
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:630-393-3400
Mailing Address - Fax:630-393-7589
Practice Address - Street 1:2 SOUTH 631 ROUTE 59
Practice Address - Street 2:SUITE E
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-393-3400
Practice Address - Fax:630-393-7589
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215040OtherBCBS PROVIDER NUMBER
ILE40239Medicare UPIN