Individual provider Active NPI

Da Som Choi

  • Family Nurse Practitioner
  • Modesto, CA
National Provider Identifier
1407484058
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95016104 Issued in CA
Practice address
1224 Scenic Dr
Modesto, CA 95350-6137
Phone
(209) 442-6077
Fax
(833) 573-2336
NPI assigned
Mar 30, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95016104 CA Primary
Ambulatory Care Registered Nurse 163WP2201X 1-154049 AL
Registered Nurse 163W00000X 95231909 CA
Family Nurse Practitioner 363LF0000X 1-154049 AL

Addresses

Primary practice location

1224 Scenic Dr
Modesto, CA 95350-6137

Mailing address

3249 Shrute Dr
Lathrop, CA 95330-8131
Phone (334) 672-2792

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210121002728 CA Practitioner - Nurse Practitioner 5294153730 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-154049ALMDFamily Nurse Practitioner
95016104CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
All Inclusive Medical Services, Inc CurrentSince Feb 1, 2021 Accepting new patients
California Mobile Medical Group Inc CurrentSince Dec 6, 2023 Accepting new patients
Shine MMG Inc CurrentSince Jan 17, 2022 Accepting new patients
Mobile Medical Group Inc Family CurrentSince Aug 24, 2021 Accepting new patients
Stockton Pace, LLC Past Accepting new patients

Locations

5900 Coyle Ave
Ste A
Carmichael, CA 95608
Phone (916) 330-4447

450 N Brand Blvd
Ste 625A
Glendale, CA 91203
Phone (818) 745-0070

130 N Brand Blvd
Ste 204
Glendale, CA 91203
Phone (818) 570-9065

655 N Central Ave
Ste 1734
Glendale, CA 91203
Phone (818) 945-6003

130 N Brand Blvd
Ste 208
Glendale, CA 91203
Phone (818) 945-6003

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17371/brand/1/csg/1/fhir/r4
  • Direct secure messaging: leah.choi.1@17371.direct.athenahealth.com

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1407484058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3249 SHRUTE DR",
            "city": "LATHROP",
            "state": "CA",
            "postal_code": "953308131",
            "telephone_number": "334-672-2792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506137",
            "telephone_number": "209-442-6077",
            "fax_number": "833-573-2336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOI",
        "first_name": "DA SOM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95016104",
            "primary": true
        },
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "AL",
            "license": "1-154049",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95231909",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-154049",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.