Provider Demographics
NPI:1619416781
Name:CHOO, YOUNGRAN
Entity type:Individual
Prefix:
First Name:YOUNGRAN
Middle Name:
Last Name:CHOO
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 1:91 DONGWA-GIL BONGDAM-EUP
Mailing Address - Street 2:
Mailing Address - City:SUWON
Mailing Address - State:KYONG KI DO
Mailing Address - Zip Code:448562
Mailing Address - Country:KR
Mailing Address - Phone:031-278-7434
Mailing Address - Fax:
Practice Address - Street 1:91DONGGHWA-GIL, BONGDAM-EUP
Practice Address - Street 2:
Practice Address - City:SUWON
Practice Address - State:KYOUNGKIDO
Practice Address - Zip Code:448562
Practice Address - Country:XK
Practice Address - Phone:031-278-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1290618405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional