Provider Demographics
NPI:1114743671
Name:JEROME CHOE DENTAL CORPORATION
Entity type:Organization
Organization Name:JEROME CHOE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:INSURB
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-648-8658
Mailing Address - Street 1:16520 BAKE PKWY STE 155
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4694
Mailing Address - Country:US
Mailing Address - Phone:949-648-8658
Mailing Address - Fax:
Practice Address - Street 1:16520 BAKE PKWY STE 155
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4694
Practice Address - Country:US
Practice Address - Phone:949-648-8658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental