Provider Demographics
NPI:1073655791
Name:CHOI, CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:CHOI
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 1:34 HIGHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3278
Mailing Address - Country:US
Mailing Address - Phone:502-852-7660
Mailing Address - Fax:502-852-8551
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:ACB - 2ND FL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-7660
Practice Address - Fax:502-852-8551
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20598Medicare UPIN
4216821Medicare PIN