MEDICARE: KYUNG H CHOI D.D.S. 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	1223G0001X	General Practice Dentistry	40560	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326166901	OTHER		NPI TYPE 1

General Provider Information

NPI Number	:	1639354913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYUNG H CHOI D.D.S. INC.

Provider Business Mailing Address
First Line	:	1928 TYLER AVE STE D
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-3622
Country	:	US
Telephone Number	:	626-443-7922
Fax Number	:	626-443-7926

Provider Business Practice Location Address
First Line	:	1928 TYLER AVE STE D
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-3622
Country	:	US
Telephone Number	:	626-443-7922
Fax Number	:	626-443-7926

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYUNG HYE CHOI
Credential	:	D.D.S.
Telephone Number	:	626-443-7922

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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