Provider Demographics
NPI:1699734723
Name:CHOI, HENRY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
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 730990
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0990
Mailing Address - Country:US
Mailing Address - Phone:972-791-1224
Mailing Address - Fax:972-692-7965
Practice Address - Street 1:2625 BOLTON BOONE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2011
Practice Address - Country:US
Practice Address - Phone:972-283-1516
Practice Address - Fax:972-283-1448
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1588207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175237001Medicaid
P00977619OtherRAILROAD MCR
TX8D8082Medicare ID - Type Unspecified
P00977619OtherRAILROAD MCR
TX175237001Medicaid