MEDICARE: JESSICA CHOI D.M.D

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	1223P0221X	Pediatric Dentistry	60144	CA

General Provider Information

NPI Number	:	1780980151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CHOI D.M.D

Provider Business Mailing Address
First Line	:	1107 FAIR OAKS AVE
Second Line	:	#233
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 FAIR OAKS AVE
Second Line	:	#233
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3311
Country	:	US
Telephone Number	:	216-269-3745
Fax Number	:

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

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	04/18/2014

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