Healthcare Provider Details

I. General information

NPI: 1174103535
Provider Name (Legal Business Name): HYE HYUN CHOI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 THOMAS JOHNSON DR STE 105
FREDERICK MD
21702-4425
US

IV. Provider business mailing address

10381 COLLEGE SQ
COLUMBIA MD
21044-4660
US

V. Phone/Fax

Practice location:
  • Phone: 301-862-6783
  • Fax:
Mailing address:
  • Phone: 443-766-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17565
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: