Provider Demographics
NPI:1942933395
Name:CHOI, ELLIN JINSUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIN
Middle Name:JINSUN
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 1:5300 TRABUCO RD APT 422
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-5794
Mailing Address - Country:US
Mailing Address - Phone:714-788-6549
Mailing Address - Fax:
Practice Address - Street 1:2862 CANYON SPRINGS PKWY UNIT A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0928
Practice Address - Country:US
Practice Address - Phone:951-300-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty