Provider Demographics
NPI:1629683339
Name:CHOE, JISOO (DDS)
Entity Type:Individual
Prefix:
First Name:JISOO
Middle Name:
Last Name:CHOE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 E 2ND ST APT 451
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4098
Mailing Address - Country:US
Mailing Address - Phone:714-392-2085
Mailing Address - Fax:
Practice Address - Street 1:232 E 2ND ST APT 451
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4098
Practice Address - Country:US
Practice Address - Phone:714-392-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1054621223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health