=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083831697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUN JOON CHOI DPD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16328 22ND AVE W UNIT#A
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98087-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-235-1615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16328 22ND AVE W UNIT#A
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98087-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-235-1615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122400000X
-----------------------------------------------------
Taxonomy Name | Denturist
-----------------------------------------------------
License Number | DN00000454
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------