Basic Information
Provider Information
NPI: 1376526954
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOY
FirstName: DANNY
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2525 S MICHIGAN AVE
Address2: B-390
City: CHICAGO
State: IL
PostalCode: 606162333
CountryCode: US
TelephoneNumber: 3125676691
FaxNumber: 3123287895
Practice Location
Address1: 2323 S WENTWORTH AVE
Address2:  
City: CHICAGO
State: IL
PostalCode: 606164615
CountryCode: US
TelephoneNumber: 3128420100
FaxNumber: 3128424967
Other Information
ProviderEnumerationDate: 11/28/2005
LastUpdateDate: 02/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X036103062ILY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
0162167901ILBCBS OF ILOTHER
036103062 / 0105IL MEDICAID


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