MEDICARE: JOON CHOE DDS INC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205424991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOON CHOE DDS INC

Provider Business Mailing Address
First Line	:	6940 BEACH BLVD UNIT D315
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-6855
Country	:	US
Telephone Number	:	714-522-2875
Fax Number	:

Provider Business Practice Location Address
First Line	:	6940 BEACH BLVD UNIT D315
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-6855
Country	:	US
Telephone Number	:	714-522-2875
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOON HO CHOE
Credential	:	DDS
Telephone Number	:	714-522-2875

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	01/07/2021

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