1124204409 NPI number — YONG CHUN CHOE DDS INC

Table of content: LAURA LESLIE GREEN NP (NPI 1144329731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124204409 NPI number — YONG CHUN CHOE DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YONG CHUN CHOE DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124204409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2675 W OLYMPIC BLVD # 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90006-2880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-739-0150
Provider Business Mailing Address Fax Number:
213-739-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2675 W OLYMPIC BLVD # 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-2880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-739-0150
Provider Business Practice Location Address Fax Number:
213-739-0250
Provider Enumeration Date:
01/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHOE
Authorized Official First Name:
YONG
Authorized Official Middle Name:
CHUN
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
213-739-0150

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)