MEDICARE: KI YOUNG CHOE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	36703	TX

General Provider Information

NPI Number	:	1043826845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KI YOUNG CHOE DDS

Provider Business Mailing Address
First Line	:	1550 EDISON ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-3705
Country	:	US
Telephone Number	:	972-490-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E PIONEER PKWY STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-6422
Country	:	US
Telephone Number	:	817-265-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	11/29/2020

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