Healthcare Provider Details

I. General information

NPI: 1588492706
Provider Name (Legal Business Name): HC DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E SOUTHERN AVE STE 101
TEMPE AZ
85282-5209
US

IV. Provider business mailing address

512 E SOUTHERN AVE STE 101
TEMPE AZ
85282-5209
US

V. Phone/Fax

Practice location:
  • Phone: 908-783-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAN CHOI
Title or Position: DOCTOR
Credential: DDS
Phone: 908-783-2311