Provider Demographics
NPI:1972165124
Name:CHOI, KI HYUN (LAC, OMD)
Entity type:Individual
Prefix:
First Name:KI
Middle Name:HYUN
Last Name:CHOI
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 EDUCATORS WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4420
Mailing Address - Country:US
Mailing Address - Phone:714-349-1679
Mailing Address - Fax:
Practice Address - Street 1:1110 W LA PALMA AVE STE 8
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2824
Practice Address - Country:US
Practice Address - Phone:714-335-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17012171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty