Provider Demographics
NPI:1417410382
Name:CHOI, KIMBERLY SU CHUNG
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SU CHUNG
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHERRY TREE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1021
Mailing Address - Country:US
Mailing Address - Phone:609-332-0148
Mailing Address - Fax:
Practice Address - Street 1:1642 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2302
Practice Address - Country:US
Practice Address - Phone:856-433-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029767001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics