Provider Demographics
NPI:1659624153
Name:CHOI, KYUNG-SOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYUNG-SOO
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 1:505 N LAKE SHORE DR
Mailing Address - Street 2:#215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3427
Mailing Address - Country:US
Mailing Address - Phone:213-245-4564
Mailing Address - Fax:
Practice Address - Street 1:505 N LAKE SHORE DR
Practice Address - Street 2:#215
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3427
Practice Address - Country:US
Practice Address - Phone:213-245-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190243341223G0001X
IL0210027541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice