Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6642 | IA |
Y | 213EG0000X | General Practice | 6642 | IA |
NPI | 1003824517 |
---|---|
Provider Name | Charles Jae Choi |
First Address | Cedar Rapids, IA 52402-5566 |
Second Address | Cedar Rapids, IA 52402-5566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0035022 | (05) | IA |