Provider Demographics
NPI:1881164309
Name:CHOE, LEANDRO MAXIMILIANO (DMD)
Entity type:Individual
Prefix:DR
First Name:LEANDRO
Middle Name:MAXIMILIANO
Last Name:CHOE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 S KINGSLEY DR APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3082
Mailing Address - Country:US
Mailing Address - Phone:323-775-7619
Mailing Address - Fax:
Practice Address - Street 1:2700 ALTON PKWY STE 225
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-2646
Practice Address - Country:US
Practice Address - Phone:949-253-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1028931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice