1619964400 NPI number — SEAN SHEUNG-FU CHOI DO

Table of content: SEAN SHEUNG-FU CHOI DO (NPI 1619964400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619964400 NPI number — SEAN SHEUNG-FU CHOI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOI
Provider First Name:
SEAN
Provider Middle Name:
SHEUNG-FU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHOI
Provider Other First Name:
SEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619964400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 536942
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32853-6942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-895-9318
Provider Business Mailing Address Fax Number:
407-895-9316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 N MILLS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-895-9318
Provider Business Practice Location Address Fax Number:
507-895-9316
Provider Enumeration Date:
10/05/2005

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: 207PE0004X , with the licence number:  OS0008419 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OS8419 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 261356500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103078000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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