Provider Demographics
NPI:1184819484
Name:CHOI, JAEWOONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAEWOONG
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 1:450 RINCON AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-7565
Mailing Address - Country:US
Mailing Address - Phone:425-894-5106
Mailing Address - Fax:
Practice Address - Street 1:20410 TOWN CENTER LN STE 190
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3230
Practice Address - Country:US
Practice Address - Phone:408-426-2635
Practice Address - Fax:408-899-4773
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552701223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice