1952584211 NPI number — DR. HAN TAE CHOE OMD (ACUPUNCTURIST)

Table of content: DR. HAN TAE CHOE OMD (ACUPUNCTURIST) (NPI 1952584211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952584211 NPI number — DR. HAN TAE CHOE OMD (ACUPUNCTURIST)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOE
Provider First Name:
HAN TAE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OMD (ACUPUNCTURIST)
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952584211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19745 COLIMA RD
Provider Second Line Business Mailing Address:
SUITE 12 ( DR MIDAS MEDICAL GROUP )
Provider Business Mailing Address City Name:
ROWLAND HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91748-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-595-5550
Provider Business Mailing Address Fax Number:
626-310-0520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7488 LIME AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-825-6846
Provider Business Practice Location Address Fax Number:
909-356-5792
Provider Enumeration Date:
12/10/2007

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: 171100000X , with the licence number:  AC11000 , 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)





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