MEDICARE: JIN CHOI DMD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1043063837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIN CHOI DMD LLC

Provider Business Mailing Address
First Line	:	4827 STATE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5542
Country	:	US
Telephone Number	:	216-741-1067
Fax Number	:

Provider Business Practice Location Address
First Line	:	4827 STATE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5542
Country	:	US
Telephone Number	:	216-741-1067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JIN HEE CHOI
Credential	:	DMD
Telephone Number	:	216-741-1067

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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