Provider Demographics
NPI:1497976575
Name:CHOI, KI SUN (DMD)
Entity Type:Individual
Prefix:MR
First Name:KI
Middle Name:SUN
Last Name:CHOI
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 1:956 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4618
Mailing Address - Country:US
Mailing Address - Phone:909-629-9741
Mailing Address - Fax:909-622-4535
Practice Address - Street 1:956 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-4618
Practice Address - Country:US
Practice Address - Phone:909-629-9741
Practice Address - Fax:909-622-4535
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice