Provider Demographics
NPI:1396405742
Name:CHOI, INSEOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:INSEOK
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:INSEOK
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:38110 MICHIGAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2843
Mailing Address - Country:US
Mailing Address - Phone:734-728-1700
Mailing Address - Fax:
Practice Address - Street 1:38110 MICHIGAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2843
Practice Address - Country:US
Practice Address - Phone:734-728-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016010841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice