Basic Information
Provider Information
NPI: 1558098863
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOI
FirstName: CHRISTOPHER
MiddleName: HYO JIN
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 16083 SW UPPER BOONES FERRY RD STE 300
Address2:  
City: PORTLAND
State: OR
PostalCode: 972247736
CountryCode: US
TelephoneNumber: 5034436156
FaxNumber:  
Practice Location
Address1: 17355 BOONES FERRY RD STE B
Address2:  
City: LAKE OSWEGO
State: OR
PostalCode: 970355225
CountryCode: US
TelephoneNumber: 5036350844
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2022
LastUpdateDate: 08/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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