Provider Demographics
NPI:1396953949
Name:CHOI, HYEONJU (DMD)
Entity type:Individual
Prefix:DR
First Name:HYEONJU
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:113 WATERWORKS WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3167
Mailing Address - Country:US
Mailing Address - Phone:949-786-2820
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-786-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist