Provider Demographics
NPI:1003963398
Name:CHOI, KEVIN HYUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HYUNG
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:HUNG
Other - Middle Name:SEOK
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4434 E. BROWN RD. STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:714-573-7100
Mailing Address - Fax:714-505-0101
Practice Address - Street 1:4434 E. BROWN RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-654-3000
Practice Address - Fax:480-654-0303
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494961223G0001X
AZ83581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1731906OtherUNITED CONCORDIA
CA906134OtherDELTA DENTAL HEALTHY FAM
CAG93335-01Medicaid