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NPI Code Detail

MEDICARE: DR. JAE W CHOI DDS

MEDICARE: DR. JAE W CHOI 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
1122300000XDentist6704OK

General Provider Information

NPI Number : 1134508641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAE W CHOI DDS
Provider Business Mailing Address
First Line : 6616 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1708
Country : US
Telephone Number : 405-445-0872
Fax Number :
Provider Business Practice Location Address
First Line : 6616 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1708
Country : US
Telephone Number : 405-445-0872
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2015
Last Update Date : 05/29/2015

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