1457435588 NPI number — DR. SUNWOONG STEVE CHOI DDS, MD

Table of content: CIDNEY OVERLY RD (NPI 1790475903)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457435588 NPI number — DR. SUNWOONG STEVE CHOI DDS, MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
CHOI

Provider First Name:
SUNWOONG

Provider Middle Name:
STEVE

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
DDS, MD

Provider Gender Code:
M

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:
1457435588

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/20/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15260 FAIRGROVE AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
LA PUENTE

Provider Business Mailing Address State Name:
CA

Provider Business Mailing Address Postal Code:
91744-1067

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
323-459-9609

Provider Business Mailing Address Fax Number:
626-917-1783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12121 WILSHIRE BLVD STE 1111

Provider Second Line Business Practice Location Address:
FRONTIER DENTAL MANAGEMENT

Provider Business Practice Location Address City Name:
LOS ANGELES

Provider Business Practice Location Address State Name:
CA

Provider Business Practice Location Address Postal Code:
90025-1188

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
310-820-9933

Provider Business Practice Location Address Fax Number:
310-820-0408

Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 1223G0001X , with the licence number: 30022305 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 1223S0112X , with the licence number: 59175 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .