Provider Demographics
NPI:1205424991
Name:JOON CHOE DDS INC
Entity type:Organization
Organization Name:JOON CHOE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOON
Authorized Official - Middle Name:HO
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-522-2875
Mailing Address - Street 1:6940 BEACH BLVD UNIT D315
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-6855
Mailing Address - Country:US
Mailing Address - Phone:714-522-2875
Mailing Address - Fax:
Practice Address - Street 1:6940 BEACH BLVD UNIT D315
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-6855
Practice Address - Country:US
Practice Address - Phone:714-522-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679802813Medicaid