Healthcare Provider Details

I. General information

NPI: 1073970554
Provider Name (Legal Business Name): JAEWOONG CHOI DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20410 TOWN CENTER LN STE 190
CUPERTINO CA
95014-3230
US

IV. Provider business mailing address

450 RINCON AVE
SUNNYVALE CA
94086-7565
US

V. Phone/Fax

Practice location:
  • Phone: 408-426-2635
  • Fax:
Mailing address:
  • Phone: 425-894-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateCA

VIII. Authorized Official

Name: JAEWOONG CHOI
Title or Position: PRESIDENT
Credential: DDS
Phone: 425-894-5106