Provider Demographics
NPI:1548930365
Name:CHOI, KYUNGSIG MICHELLE
Entity type:Individual
Prefix:
First Name:KYUNGSIG
Middle Name:MICHELLE
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 1:866 S WESTMORELAND AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2372
Mailing Address - Country:US
Mailing Address - Phone:213-459-5800
Mailing Address - Fax:
Practice Address - Street 1:866 S WESTMORELAND AVE STE 101B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2372
Practice Address - Country:US
Practice Address - Phone:213-459-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist