Basic Information
Provider Information
NPI: 1316493851
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOI
FirstName: JI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2050 E ALGONQUIN RD
Address2: 610
City: SCHAUMBURG
State: IL
PostalCode: 601734144
CountryCode: US
TelephoneNumber: 8889884066
FaxNumber: 8474964850
Practice Location
Address1: 1915 S GREGG ST
Address2:  
City: BIG SPRING
State: TX
PostalCode: 797205434
CountryCode: US
TelephoneNumber: 8889884066
FaxNumber: 8474964850
Other Information
ProviderEnumerationDate: 08/25/2016
LastUpdateDate: 08/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X32345TXY Dental ProvidersDentist 

No ID Information.


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