Healthcare Provider Details

I. General information

NPI: 1184819484
Provider Name (Legal Business Name): JAEWOONG CHOI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 06/03/2019
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: 408-899-4773
Mailing address:
  • Phone: 425-894-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55270
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number55270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: