Provider Demographics
NPI:1326214941
Name:CHOI, CHRISTOPHER (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 MILLIKEN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7471
Mailing Address - Country:US
Mailing Address - Phone:909-581-7761
Mailing Address - Fax:
Practice Address - Street 1:8112 MILLIKEN AVE
Practice Address - Street 2:STE 102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7471
Practice Address - Country:US
Practice Address - Phone:909-581-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 257968204E00000X
NY50 0532561223S0112X
CAOMS1021223S0112X
CAA124593208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02866815Medicaid