Provider Demographics
NPI:1255391710
Name:CHOI, JUNGHWAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUNGHWAN
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 GARDEN GROVE BLVD
Mailing Address - Street 2:STE. 405
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1902
Mailing Address - Country:US
Mailing Address - Phone:714-534-0744
Mailing Address - Fax:714-534-0785
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:STE. 405
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1902
Practice Address - Country:US
Practice Address - Phone:714-534-0744
Practice Address - Fax:714-534-0785
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72957208800000X
CAG072957208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00708070OtherMEDICARE RAILROAD
G61915Medicare UPIN
CAG61915Medicare UPIN
BC742ZMedicare PIN