MEDICARE: DR. CHAE WON CHOI D.D.S.

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	1223G0001X	General Practice Dentistry	8654	CO

General Provider Information

NPI Number	:	1306062088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAE WON CHOI D.D.S.

Provider Business Mailing Address
First Line	:	891 14TH ST UNIT 1010
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-3257
Country	:	US
Telephone Number	:	303-246-0685
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 W 124TH AVE STE 170
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-1716
Country	:	US
Telephone Number	:	303-452-3982
Fax Number	:	303-452-2949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/06/2011

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