1336767888 NPI number — DR. AIRY CHOI DMD

Table of content: DR. AIRY CHOI DMD (NPI 1336767888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336767888 NPI number — DR. AIRY CHOI DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOI
Provider First Name:
AIRY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

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:
1336767888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 GAGE AVE APT 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76109-1588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-261-9755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5710 WATAUGA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATAUGA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76148-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-281-2061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2020

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:  36331 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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