Provider Demographics
NPI:1619757788
Name:CHOE, JEROME INSURB (DDS)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:INSURB
Last Name:CHOE
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 1:202 GUINEVERE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2810
Mailing Address - Country:US
Mailing Address - Phone:949-648-8658
Mailing Address - Fax:
Practice Address - Street 1:16520 BAKE PKWY STE 155
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4694
Practice Address - Country:US
Practice Address - Phone:949-648-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1092441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice