Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A139677 | CA |
Y | 111NI0900X | Internist | A139677 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | A139677 | CA |
NPI | 1154748358 |
---|---|
Provider Name | Shelley Jung Yeon Choi |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-1460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A139677 | STATE LICENSE (01) | CA |
FC5706518 | DEA (01) | CA |