Provider Demographics
NPI:1386738706
Name:CHOI, MIJA (MD)
Entity type:Individual
Prefix:DR
First Name:MIJA
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 149TH PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4919
Mailing Address - Country:US
Mailing Address - Phone:718-939-3927
Mailing Address - Fax:718-939-1879
Practice Address - Street 1:38-01 149TH PLACE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-939-3927
Practice Address - Fax:718-939-1879
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00963882-2Medicaid
NYE40774Medicare UPIN
NY00963882-2Medicaid