Healthcare Provider Details

I. General information

NPI: 1215322359
Provider Name (Legal Business Name): JUNGINN CHOI D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 E 78TH ST FL 5
NEW YORK NY
10075-1216
US

IV. Provider business mailing address

261 E 78TH ST FL 5
NEW YORK NY
10075-1216
US

V. Phone/Fax

Practice location:
  • Phone: 646-864-1808
  • Fax:
Mailing address:
  • Phone: 646-864-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02560200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number057667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: