MEDICARE: DR. DIANA KEE-SUN CHOI D.D.S.

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	08725	IA
2	1223E0200X	Endodontics	08725	IA

General Provider Information

NPI Number	:	1437464559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA KEE-SUN CHOI D.D.S.

Provider Business Mailing Address
First Line	:	5005 N PIEDRAS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79920-5002
Country	:	US
Telephone Number	:	915-742-5935
Fax Number	:	915-742-7462

Provider Business Practice Location Address
First Line	:	5005 N PIEDRAS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79920-5002
Country	:	US
Telephone Number	:	915-742-5935
Fax Number	:	915-742-7462

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

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	06/05/2016

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