Healthcare Provider Details

I. General information

NPI: 1326214941
Provider Name (Legal Business Name): CHRISTOPHER CHOI DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 MILLIKEN AVE STE 102
RANCHO CUCAMONGA CA
91730-7471
US

IV. Provider business mailing address

8112 MILLIKEN AVE STE 102
RANCHO CUCAMONGA CA
91730-7471
US

V. Phone/Fax

Practice location:
  • Phone: 909-581-7761
  • Fax:
Mailing address:
  • Phone: 909-581-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number60 257968
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50 053256
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOMS102
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA124593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: