Provider Demographics
NPI:1265768998
Name:CHOI, JO JUNG (DDS)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:JUNG
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 1:4501 ALHAMBRA DR
Mailing Address - Street 2:234
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7146
Mailing Address - Country:US
Mailing Address - Phone:530-564-4184
Mailing Address - Fax:
Practice Address - Street 1:791 E MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-2920
Practice Address - Country:US
Practice Address - Phone:800-579-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice