Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 27131 | TX |
Y | 1223P0300X | Periodontist | 30-023395 | OH |
NPI | 1063709848 |
---|---|
Provider Name | Dr. Daniel Choi |
First Address | Addison, TX 75001-4035 |
Second Address | Addison, TX 75001-4035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 30/06/2011 |