MEDICARE: DR. BYEONG C CHOI P.C

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	1223G0001X	General Practice Dentistry	048369	NY

General Provider Information

NPI Number	:	1376812768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYEONG C CHOI P.C

Provider Business Mailing Address
First Line	:	400 N BROADWAY
Second Line	:	#B
City	:	JERICHO
State	:	NY
Zip	:	11753-2113
Country	:	US
Telephone Number	:	516-433-4440
Fax Number	:	516-433-4440

Provider Business Practice Location Address
First Line	:	400 N BROADWAY
Second Line	:	#B
City	:	JERICHO
State	:	NY
Zip	:	11753-2113
Country	:	US
Telephone Number	:	516-433-4440
Fax Number	:	516-433-4440

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

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/14/2011

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