Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 34316 | CA |
NPI | 1003905829 |
---|---|
Provider Name | Dr. Luke Kyung-Goo Choi |
First Address | Fullerton, CA 92831-3811 |
Second Address | Fullerton, CA 92831-3811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |