Provider Demographics
NPI:1063842029
Name:CHOI, RAYMOND Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:Y
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:Y
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:17502 W. IRVINE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-838-1111
Mailing Address - Fax:714-838-1213
Practice Address - Street 1:17502 W. IRVINE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-838-1111
Practice Address - Fax:714-838-1213
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952521932OtherTYPE 1
1952521932OtherTYPE 1