1003274515 NPI number — MS. SUSAN MYUNGHEE CHOI LCSW

Table of content: MS. SUSAN MYUNGHEE CHOI LCSW (NPI 1003274515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003274515 NPI number — MS. SUSAN MYUNGHEE CHOI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOI
Provider First Name:
SUSAN
Provider Middle Name:
MYUNGHEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHOI
Provider Other First Name:
MYUNGHEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003274515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 CHADBOURNE RD. SUITE E
Provider Second Line Business Mailing Address:
ALDEA CHILDREN & FAMILY SERVICES
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-425-9670
Provider Business Mailing Address Fax Number:
707-425-9880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 CHADBOURNE RD. SUITE E
Provider Second Line Business Practice Location Address:
ALDEA CHILDREN & FAMILY SERVICES
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94534-9600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-425-9670
Provider Business Practice Location Address Fax Number:
707-425-9880
Provider Enumeration Date:
01/29/2016

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: 101YM0800X , with the licence number:  ASW62160 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LCSW81087 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW81087 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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