Provider Demographics
NPI:1861805954
Name:CHOI, WESLEY WON YONG (DDS)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:WON YONG
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28006 RIDGEFOREST CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3267
Mailing Address - Country:US
Mailing Address - Phone:310-227-1992
Mailing Address - Fax:
Practice Address - Street 1:1525 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3835
Practice Address - Country:US
Practice Address - Phone:626-403-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0412561223P0221X
CA1042431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty