Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 105462 | CA |
NPI | 1629683339 |
---|---|
Provider Name | Jisoo Choe |
First Address | Los Angeles, CA 90012-4098 |
Second Address | Los Angeles, CA 90012-4098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |