=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861882813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOON HO CHOE DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2015
-----------------------------------------------------
Last Update Date | 01/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 S ALAMEDA ST SUITE 213
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-631-2555
-----------------------------------------------------
Fax | 213-631-2556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 S ALAMEDA ST SUITE 213
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-631-2555
-----------------------------------------------------
Fax | 213-631-2556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. GYOUNG-HWA JU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 21363125555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------