Provider Demographics
NPI:1558889170
Name:CHOI, JI WOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:JI WOUNG
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 TRINITY PKWY APT 173
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2428
Mailing Address - Country:US
Mailing Address - Phone:314-882-2658
Mailing Address - Fax:
Practice Address - Street 1:4322 RAVENSWORTH RD # VA
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5630
Practice Address - Country:US
Practice Address - Phone:703-256-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice