Mal Bong Choi, DDS

Key facts

NPI

1063671022

Entity type

Individual (NPI type 1)

Primary specialty

Endodontics 1223E0200X

License

22DI01912300 (NJ)

Practice address

605 Broad Ave
Suit # 203
Ridgefield, NJ 07657-1697

Phone

(201) 943-9424

Fax

(201) 943-9485

NPI assigned

Jun 5, 2008

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 15, 2009.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260835200000",
    "number": "1063671022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 HENRY HUDSON PKWY",
            "address_2": "APT 1F",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104631306",
            "telephone_number": "646-763-1145",
            "fax_number": "718-601-3964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 BROAD AVE",
            "address_2": "SUIT # 203",
            "city": "RIDGEFIELD",
            "state": "NJ",
            "postal_code": "076571697",
            "telephone_number": "201-943-9424",
            "fax_number": "201-943-9485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOI",
        "first_name": "MAL BONG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2009-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NJ",
            "license": "22DI01912300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Ridgefield, NJ · Endodontics in New Jersey