Healthcare Provider Details

I. General information

NPI: 1750061107
Provider Name (Legal Business Name): JI WON CHOE D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date: 02/26/2024
Reactivation Date: 11/19/2025

III. Provider practice location address

3767 AVOCADO BLVD
LA MESA CA
91941-7301
US

IV. Provider business mailing address

7770 WESTSIDE DR APT 202
SAN DIEGO CA
92108-1214
US

V. Phone/Fax

Practice location:
  • Phone: 619-729-2323
  • Fax:
Mailing address:
  • Phone: 347-739-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: