Provider Demographics
NPI:1497473003
Name:CHOI, KYU WAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYU WAN
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2959 NORTHERN BLVD APT 67D
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6478
Mailing Address - Country:US
Mailing Address - Phone:401-871-9147
Mailing Address - Fax:
Practice Address - Street 1:3366 PARK AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3770
Practice Address - Country:US
Practice Address - Phone:516-826-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0625681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics