Individual provider Active NPI

Jang Choi, DMD

  • Periodontics
  • Latham, NY
National Provider Identifier
1093873325
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
051459-1 Issued in NY
Practice address
1201 Troy Schenectady Rd
Latham, NY 12110-1028
Phone
(518) 785-0384
Fax
(518) 785-0243
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 051459-1 NY Primary

Addresses

Primary practice location

1201 Troy Schenectady Rd
Latham, NY 12110-1028

Mailing address

6 Executive Park Dr
Suite 6C
Clifton Park, NY 12065-5601
Phone (518) 348-0240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151215000233 NY Order and Referring Only - DentistPractitioner - Dentist 4082915178

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
051459-1NYMDPeriodontist
051459NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Area Hudson Valley New York Dental, PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247443200000",
    "number": "1093873325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE PARK DR",
            "address_2": "SUITE 6C",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120655601",
            "telephone_number": "518-348-0240",
            "fax_number": "518-348-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 TROY SCHENECTADY RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121101028",
            "telephone_number": "518-785-0384",
            "fax_number": "518-785-0243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOI",
        "first_name": "JANG",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2009-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "051459-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

Verify at the official NPI Registry.