Provider Demographics
NPI:1821117623
Name:CHOI, JAE HO (DIP OM LAC)
Entity Type:Individual
Prefix:
First Name:JAE HO
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DIP OM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1144
Mailing Address - Country:US
Mailing Address - Phone:201-838-7427
Mailing Address - Fax:201-585-2530
Practice Address - Street 1:123 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1144
Practice Address - Country:US
Practice Address - Phone:201-838-7427
Practice Address - Fax:201-585-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00044900171100000X
NY02945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist