Provider Demographics
NPI:1942360599
Name:CHOI, TAE YUL (DDS)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:YUL
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 1:110 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605
Mailing Address - Country:US
Mailing Address - Phone:201-346-9991
Mailing Address - Fax:201-346-9993
Practice Address - Street 1:110 BROAD AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605
Practice Address - Country:US
Practice Address - Phone:201-346-9991
Practice Address - Fax:201-346-9993
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI014699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist