Provider Demographics
NPI:1043826845
Name:CHOE, KI YOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:KI YOUNG
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3705
Mailing Address - Country:US
Mailing Address - Phone:972-490-1600
Mailing Address - Fax:
Practice Address - Street 1:1250 E PIONEER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6422
Practice Address - Country:US
Practice Address - Phone:817-265-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist