Basic Information
Provider Information
NPI: 1003294976
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOI
FirstName: MICHAEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2041 GEORGIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200600001
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2041 GEORGIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200600001
CountryCode: US
TelephoneNumber: 6462397552
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/12/2015
LastUpdateDate: 06/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223S0112X16797MDY Dental ProvidersDentistOral and Maxillofacial Surgery
1223S0112XDEN1001994DCN Dental ProvidersDentistOral and Maxillofacial Surgery

No ID Information.


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