Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 051459-1 | NY |
NPI | 1093873325 |
---|---|
Provider Name | Dr. Jang Choi |
First Address | Clifton Park, NY 12065-5601 |
Second Address | Latham, NY 12110-1028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 13/07/2009 |