Provider Demographics
NPI:1538981212
Name:CHOI, HYOUNG JA
Entity type:Individual
Prefix:
First Name:HYOUNG JA
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 BAROQUE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6737
Mailing Address - Country:US
Mailing Address - Phone:347-622-1321
Mailing Address - Fax:
Practice Address - Street 1:1401 ARVILLE ST STE G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0537
Practice Address - Country:US
Practice Address - Phone:702-738-0515
Practice Address - Fax:702-527-7698
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant