Individual provider Active NPI

Johnny Jaehwan Choi, M.D.

  • Internal Medicine Physician
  • Upland, CA
National Provider Identifier
1376640714
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A97680 Issued in CA
Practice address
141 W Foothill Blvd
Upland, CA 91786-8705
Phone
(909) 296-8800
NPI assigned
Sep 20, 2006
Last updated
Aug 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 222248 MA
Internal Medicine Physician 207R00000X A97680 CA Primary

Addresses

Primary practice location

141 W Foothill Blvd
Upland, CA 91786-8705

Mailing address

12900 Park Plaza Dr Ste 150
Cerritos, CA 90703-9329
Phone (562) 977-4639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080417000237 CA Practitioner - Internal Medicine 8224090238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Tufts University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Razi Medical Group IncGroup PAC ID 1456580737, 8 clinicians

Practice addresses (Care Compare)

12740 Hesperia Rd
Suite a
Victorville, CA 92395-8306
Phone (760) 713-6969

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A97680CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shima Hadidchi MD a Professional Corp CurrentSince Oct 1, 2021 Accepting new patients
Lakeside Medical Organization, a Medical Group Inc. Internal Medicine CurrentSince Jul 27, 2020 Accepting new patients
Caremore Health Plan PastSince Sep 1, 2019 Accepting new patients
Caremore Medical Group Inc Internal Medicine Past Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Past Accepting new patients
Heritage Provider Network, Inc. Past Accepting new patients

Locations

1500 S Central Ave
Ste 200
Glendale, CA 91204
Phone (818) 242-8916

8510 Balboa Blvd
Ste 150
Northridge, CA 91325
Phone (818) 637-2000

12740 Hesperia Rd
Ste A
Victorville, CA 92395
Phone (760) 713-6969

12740 Hesperia Rd
Ste B
Victorville, CA 92395
Phone (760) 713-6969

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EECJBD
  • Direct secure messaging: johnny.choi.p1@direct.lakeside.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1376640714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 PARK PLAZA DR STE 150",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907039329",
            "telephone_number": "562-977-4639",
            "fax_number": "562-741-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W FOOTHILL BLVD",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868705",
            "telephone_number": "909-296-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOI",
        "first_name": "JOHNNY",
        "middle_name": "JAEHWAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "222248",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A97680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.