Provider Demographics
NPI:1558061879
Name:CHOI, JUNYOUNG
Entity type:Individual
Prefix:
First Name:JUNYOUNG
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 MASSACHUSETTS AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4349
Mailing Address - Country:US
Mailing Address - Phone:617-468-8986
Mailing Address - Fax:
Practice Address - Street 1:17 THOMASTON COMMONS WAY
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3524
Practice Address - Country:US
Practice Address - Phone:207-593-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN51721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice