Provider Demographics
NPI:1366751976
Name:CHOI, BOKYU (DMD)
Entity type:Individual
Prefix:DR
First Name:BOKYU
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13890 BRADDOCK RD
Mailing Address - Street 2:STE305
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2435
Mailing Address - Country:US
Mailing Address - Phone:703-815-2875
Mailing Address - Fax:703-815-2876
Practice Address - Street 1:13890 BRADDOCK RD
Practice Address - Street 2:STE305
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:703-815-2875
Practice Address - Fax:703-815-2876
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037760122300000X
VA0401413070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist