MEDICARE: SOOKYOUNG CHOI DDS

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	056957	NY

General Provider Information

NPI Number	:	1841559887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOKYOUNG CHOI DDS

Provider Business Mailing Address
First Line	:	113 CRYSTAL SPRINGS LN
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1477
Country	:	US
Telephone Number	:	716-631-2728
Fax Number	:	716-631-5821

Provider Business Practice Location Address
First Line	:	4927 MAIN ST
Second Line	:	ROBERT J LAQCARRUBBA DDS PC
City	:	AMHERST
State	:	NY
Zip	:	14226-4081
Country	:	US
Telephone Number	:	716-631-2728
Fax Number	:	716-631-5821

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

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	01/12/2016

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