Provider Demographics
NPI:1023239621
Name:CHOI, WANWOO
Entity type:Individual
Prefix:
First Name:WANWOO
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE6
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-623-8090
Mailing Address - Fax:770-623-8090
Practice Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE6
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-623-8090
Practice Address - Fax:770-623-8090
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist