Provider Demographics
NPI:1073138558
Name:CHOI, MIJIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIJIN
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 8TH AVE N APT 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5173
Mailing Address - Country:US
Mailing Address - Phone:949-648-0638
Mailing Address - Fax:
Practice Address - Street 1:285 8TH AVE N APT 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5173
Practice Address - Country:US
Practice Address - Phone:949-648-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE610426691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice