Healthcare Provider Details

I. General information

NPI: 1962661728
Provider Name (Legal Business Name): MIJIN CHOI DDS,MS,FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 BROADWAY STE 350
NEW YORK NY
10003-9616
US

IV. Provider business mailing address

726 BROADWAY STE 350
NEW YORK NY
10003-9616
US

V. Phone/Fax

Practice location:
  • Phone: 212-443-1322
  • Fax: 212-443-1331
Mailing address:
  • Phone: 212-443-1322
  • Fax: 212-443-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051887
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number051887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: