Provider Demographics
NPI:1598808131
Name:CHOI, YOUNG MI (DMD MS)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:MI
Last Name:CHOI
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 W LAKESIDE PL
Mailing Address - Street 2:1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6638
Mailing Address - Country:US
Mailing Address - Phone:312-961-3179
Mailing Address - Fax:
Practice Address - Street 1:849 W LAKESIDE PL
Practice Address - Street 2:1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6638
Practice Address - Country:US
Practice Address - Phone:312-961-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics