MEDICARE: DR. DANIEL J CHOI DMD

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	10623	WA

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
2	4408CH	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1548341985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL J CHOI DMD

Provider Business Mailing Address
First Line	:	4408 PACIFIC AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1119
Country	:	US
Telephone Number	:	360-438-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 N 182ND ST # 201
Second Line	:
City	:	SHORELINE
State	:	WA
Zip	:	98133-4402
Country	:	US
Telephone Number	:	206-546-2424
Fax Number	:	206-546-2425

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/12/2016

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