Provider Demographics
NPI:1538311329
Name:CHOI, YOUNG JIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG JIN
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 GRAND CONCOURSE
Mailing Address - Street 2:STE 2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5524
Mailing Address - Country:US
Mailing Address - Phone:718-901-8110
Mailing Address - Fax:718-901-8121
Practice Address - Street 1:4500 LEGACY DR STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-618-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538311329Medicaid