Provider Demographics
NPI:1801899893
Name:CHOI, JENNIFER Y (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:Y
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 1:2843W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3624
Mailing Address - Country:US
Mailing Address - Phone:773-267-8600
Mailing Address - Fax:
Practice Address - Street 1:6600 MERCY CT
Practice Address - Street 2:STE 140
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3198
Practice Address - Country:US
Practice Address - Phone:916-961-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice