Provider Demographics
NPI:1386974483
Name:CHOI, JUDY (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
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:PO BOX 51342
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5642
Mailing Address - Country:US
Mailing Address - Phone:714-456-6054
Mailing Address - Fax:888-378-4524
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6054
Practice Address - Fax:888-378-4524
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123742208800000X
TXBT3354272208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1237420Medicaid
CA0A1237420Medicaid