Healthcare Provider Details

I. General information

NPI: 1811371099
Provider Name (Legal Business Name): JUN HYEOK JEREMIAH CHOI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 THEODORE ST
CREST HILL IL
60403-1881
US

IV. Provider business mailing address

209 S O CONNOR RD
IRVING TX
75060-2950
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-1700
  • Fax:
Mailing address:
  • Phone: 972-251-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number42265
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019030307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: