Provider Demographics
NPI:1083831697
Name:CHOI, EUN JOON (DPD)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:JOON
Last Name:CHOI
Suffix:
Gender:M
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16328 22ND AVE W
Mailing Address - Street 2:UNIT#A
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-2540
Mailing Address - Country:US
Mailing Address - Phone:206-235-1615
Mailing Address - Fax:
Practice Address - Street 1:16328 22ND AVE W
Practice Address - Street 2:UNIT#A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-2540
Practice Address - Country:US
Practice Address - Phone:206-235-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000454122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5052394Medicaid