Basic Information
| Provider Information | |||||||||
| NPI: | 1477553279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOI | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | YOUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 MARSHALL WAY | ||||||||
| Address2: | ANESTHESIA DEPT. | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956676533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306221441 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 MARSHALL WAY | ||||||||
| Address2: | ANESTHESIA DEPT. | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956676533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306221441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 20A8722 | CA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 020A87220 | 01 | CA | BLUE SHIELD OF CA | OTHER | YYY20507Y | 05 | CA | MEDICAID | 00AX87220 | 05 | CA | MEDICAID |