Provider Demographics
NPI:1801378872
Name:CHOI, KANG IL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KANG
Middle Name:IL
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 1:1654 GOLDEN ROD AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4213
Mailing Address - Country:US
Mailing Address - Phone:480-646-0180
Mailing Address - Fax:
Practice Address - Street 1:224 E BASE LINE RD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3506
Practice Address - Country:US
Practice Address - Phone:909-874-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice