Provider Demographics
NPI:1497473003
Name:CHOI, KYU WAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KYU WAN
Middle Name:
Last Name:CHOI
Suffix:
Gender:
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:26 COURT ST STE 1507
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1115
Mailing Address - Country:US
Mailing Address - Phone:401-871-9147
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1507
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1115
Practice Address - Country:US
Practice Address - Phone:718-643-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0625681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics