Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000454 | WA |
NPI | 1083831697 |
---|---|
Provider Name | Eun Joon Choi |
First Address | Lynnwood, WA 98087-2540 |
Second Address | Lynnwood, WA 98087-2540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5052394 | (05) | WA |