Provider Demographics
NPI:1003051541
Name:HO, CUONG CHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:CHI
Last Name:HO
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 1:156 W PORTAL AVE # C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1306
Mailing Address - Country:US
Mailing Address - Phone:415-564-2200
Mailing Address - Fax:415-520-6737
Practice Address - Street 1:156 W PORTAL AVE # C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1306
Practice Address - Country:US
Practice Address - Phone:415-564-2200
Practice Address - Fax:415-520-6737
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice