Provider Demographics
NPI:1740766443
Name:CHOI, YE EUN
Entity Type:Individual
Prefix:
First Name:YE EUN
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 BLACKMON DR STE 310
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6197
Mailing Address - Country:US
Mailing Address - Phone:678-203-3462
Mailing Address - Fax:
Practice Address - Street 1:2570 BLACKMON DR STE 310
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6197
Practice Address - Country:US
Practice Address - Phone:678-203-3462
Practice Address - Fax:678-389-6421
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0156331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice