Healthcare Provider Details

I. General information

NPI: 1295083111
Provider Name (Legal Business Name): CAROLYN CHOI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 SW CRESCENT ST STE 106
BEAVERTON OR
97005
US

IV. Provider business mailing address

PO BOX 6149
BEAVERTON OR
97007-0149
US

V. Phone/Fax

Practice location:
  • Phone: 503-718-3675
  • Fax: 503-924-6722
Mailing address:
  • Phone: 503-352-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9780
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: