Provider Demographics
NPI:1780668681
Name:CHOI, LISA PARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:PARK
Last Name:CHOI
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 1:618TH DENTAL CO. DC#2 UNIT #15652
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:US
Mailing Address - Phone:0118227-916-4779
Mailing Address - Fax:
Practice Address - Street 1:618TH DENTAL CO. DC#2 UNIT #15652
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:0118227-916-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice