MEDICARE: DR. JENNIFER Y 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	50229	CA

General Provider Information

NPI Number	:	1801899893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER Y CHOI D.D.S.

Provider Business Mailing Address
First Line	:	2843W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3624
Country	:	US
Telephone Number	:	773-267-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 MERCY CT
Second Line	:	STE 140
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3198
Country	:	US
Telephone Number	:	916-961-6644
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/27/2015

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