Provider Demographics
NPI:1306062088
Name:CHOI, CHAE WON (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAE
Middle Name:WON
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:WINSTON
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:891 14TH ST UNIT 1010
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3257
Mailing Address - Country:US
Mailing Address - Phone:303-246-0685
Mailing Address - Fax:
Practice Address - Street 1:905 W 124TH AVE STE 170
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1716
Practice Address - Country:US
Practice Address - Phone:303-452-3982
Practice Address - Fax:303-452-2949
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice