1013546357 NPI number — DR. CRYSTAL DIANE CHOI PHARMD

Table of content: DR. CRYSTAL DIANE CHOI PHARMD (NPI 1013546357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013546357 NPI number — DR. CRYSTAL DIANE CHOI PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOI
Provider First Name:
CRYSTAL
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLEASON
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013546357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 SPRINGFIELD ST APT 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91711-5261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-208-0930
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
349 SPRINGFIELD ST APT 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91711-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-208-0930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  P8774 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)