Provider Demographics
NPI:1083476477
Name:CHOI FAMILY DENTAL
Entity Type:Organization
Organization Name:CHOI FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WOOYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-738-4770
Mailing Address - Street 1:13400 S ROUTE 59 UNIT 104
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5838
Mailing Address - Country:US
Mailing Address - Phone:815-676-6976
Mailing Address - Fax:
Practice Address - Street 1:13400 S ROUTE 59 UNIT 104
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5838
Practice Address - Country:US
Practice Address - Phone:815-676-6976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental