Healthcare Provider Details

I. General information

NPI: 1548998073
Provider Name (Legal Business Name): DAVI Y CHOI DDS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 BROCKTON AVE STE 112
RIVERSIDE CA
92506-2208
US

IV. Provider business mailing address

6216 BROCKTON AVE STE 112
RIVERSIDE CA
92506-2208
US

V. Phone/Fax

Practice location:
  • Phone: 951-779-8862
  • Fax: 951-888-1616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW CHOI
Title or Position: DENTIST
Credential: DDS
Phone: 951-444-0999