Provider Demographics
NPI:1326822354
Name:CHOE, FERNANDO JAVIER (DMD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JAVIER
Last Name:CHOE
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 1:716 S HARVARD BLVD APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2527
Mailing Address - Country:US
Mailing Address - Phone:323-775-7621
Mailing Address - Fax:
Practice Address - Street 1:716 S HARVARD BLVD APT 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2527
Practice Address - Country:US
Practice Address - Phone:323-775-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist