Provider Demographics
NPI:1376761429
Name:CHOI, JOSEPH KYUNGJO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KYUNGJO
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 1:670 S GENTRY LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3653
Mailing Address - Country:US
Mailing Address - Phone:630-965-4988
Mailing Address - Fax:
Practice Address - Street 1:1227 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3455
Practice Address - Country:US
Practice Address - Phone:630-965-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023417122300000X
CADDS54345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist