Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 50756 | CA |
NPI | 1114130788 |
---|---|
Provider Name | Dr. Key Soon Hu Choi |
First Address | Roseville, CA 95661-3967 |
Second Address | Roseville, CA 95661-3967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |