Healthcare Provider Details

I. General information

NPI: 1558397257
Provider Name (Legal Business Name): LOK TIM CHOY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 WOODSIDE RD STE 100
REDWOOD CITY CA
94061-3462
US

IV. Provider business mailing address

555 W BENJAMIN HOLT DR BUILDING B
STOCKTON CA
95207-3839
US

V. Phone/Fax

Practice location:
  • Phone: 650-716-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: