Provider Demographics
NPI:1093879280
Name:CHOI, SUNGWON (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNGWON
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11796 GREAT OWL CIR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1173
Mailing Address - Country:US
Mailing Address - Phone:703-996-4697
Mailing Address - Fax:
Practice Address - Street 1:12359 SUNRISE VALLEY DR STE 250
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3494
Practice Address - Country:US
Practice Address - Phone:703-860-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice