Basic Information
| Provider Information | |||||||||
| NPI: | 1093899718 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHOI | ||||||||
| FirstName: | MINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | HARRIS AND SMITH OB GYN | ||||||||
| Address2: | 4116 CAPITOL STREET | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27704 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2100 ERWIN RD | ||||||||
| Address2: | DUKE UNIV MED CENTER | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196204467 | ||||||||
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| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 93-00666 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 8922326 | 05 | NC | MEDICAID |