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General NPI Number Information
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NPI Number | 1861805954
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Entity Type | Individual
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Provider Name | WESLEY WON YONG CHOI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 1525 FAIR OAKS AVE
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3835
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Country | US
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Telephone | 626-403-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 28006 RIDGEFOREST CT
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3267
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Country | US
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Telephone | 310-227-1992
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS041256
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 104243
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License Number State | CA
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