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General NPI Number Information
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NPI Number | 1073970554
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Entity Type | Organization
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Legal Business Name | JAEWOONG CHOI DDS, INC.
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 20410 TOWN CENTER LN STE 190
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City | CUPERTINO
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State | CA
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Zip | 95014-3230
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Country | US
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Telephone | 408-426-2635
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Fax |
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Provider Business Mailing Address
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Address Line | 450 RINCON AVE
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City | SUNNYVALE
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State | CA
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Zip | 94086-7565
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Country | US
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Telephone | 425-894-5106
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAEWOONG CHOI
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Credential | DDS
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Telephone | 425-894-5106
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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 |
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License Number State | CA
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