Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI 02401100 | NJ |
NPI | 1003145129 |
---|---|
Provider Name | Dr. John Junghan Choi |
First Address | Staten Island, NY 10314-5982 |
Second Address | Union, NJ 07083-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2009 |
Last Update Date | 19/12/2009 |