Healthcare Provider Details

I. General information

NPI: 1982366381
Provider Name (Legal Business Name): JUNGHUN FREDERICK CHOI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRED CHOI DDS

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

3119 HANNA DR NE
LACEY WA
98516-7169
US

V. Phone/Fax

Practice location:
  • Phone: 315-774-8258
  • Fax:
Mailing address:
  • Phone: 951-235-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number106392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: