Provider Demographics
NPI:1376812768
Name:CHOI, BYEONG C (PC)
Entity Type:Individual
Prefix:DR
First Name:BYEONG
Middle Name:C
Last Name:CHOI
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BROADWAY
Mailing Address - Street 2:#B
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2113
Mailing Address - Country:US
Mailing Address - Phone:516-433-4440
Mailing Address - Fax:516-433-4440
Practice Address - Street 1:400 N BROADWAY
Practice Address - Street 2:#B
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2113
Practice Address - Country:US
Practice Address - Phone:516-433-4440
Practice Address - Fax:516-433-4440
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0483691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice