Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD61119613 | WA |
NPI | 1043604325 |
---|---|
Provider Name | Young Mike Choi |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Renton, WA 98057-5540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 19/03/2021 |