Healthcare Provider Details

I. General information

NPI: 1780175760
Provider Name (Legal Business Name): JOHN CHOI I DN60731854
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 AUBURN WAY N
AUBURN WA
98002-4148
US

IV. Provider business mailing address

9597 CENTRAL AVE
MONTCLAIR CA
91763-2424
US

V. Phone/Fax

Practice location:
  • Phone: 833-900-1050
  • Fax: 909-621-3125
Mailing address:
  • Phone: 833-900-1050
  • Fax: 909-621-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN60737854
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: