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General NPI Number Information
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NPI Number | 1063671022
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Entity Type | Individual
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Provider Name | MAL BONG CHOI DDS
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Gender | Female
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 605 BROAD AVE SUIT # 203
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-1697
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Country | US
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Telephone | 201-943-9424
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Fax | 201-943-9485
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Provider Business Mailing Address
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Address Line | 3530 HENRY HUDSON PKWY APT 1F
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City | BRONX
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State | NY
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Zip | 10463-1306
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Country | US
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Telephone | 646-763-1145
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Fax | 718-601-3964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI01912300
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License Number State | NJ
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