Provider Demographics
NPI:1922394550
Name:JOHN JK CHOI, DMD PC
Entity Type:Organization
Organization Name:JOHN JK CHOI, DMD PC
Other - Org Name:JOHN JK CHOI DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRIMARY SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-754-9322
Mailing Address - Street 1:4 PROGRESS ST
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1199
Mailing Address - Country:US
Mailing Address - Phone:908-754-9322
Mailing Address - Fax:908-755-9364
Practice Address - Street 1:4 PROGRESS ST
Practice Address - Street 2:SIOTE A-2
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1199
Practice Address - Country:US
Practice Address - Phone:908-754-9322
Practice Address - Fax:908-755-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI018664261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental