Provider Demographics
NPI:1548490725
Name:CHOI, MICHAEL MINHO (LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MINHO
Last Name:CHOI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520A HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1316
Mailing Address - Country:US
Mailing Address - Phone:917-816-3444
Mailing Address - Fax:
Practice Address - Street 1:14327 ROOSEVELT AVE FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6139
Practice Address - Country:US
Practice Address - Phone:917-816-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist