Provider Demographics
NPI:1003282997
Name:CHO, EUNSANG MICHAEL
Entity Type:Individual
Prefix:
First Name:EUNSANG
Middle Name:MICHAEL
Last Name:CHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20221 AURORA AVE N
Mailing Address - Street 2:APT 416
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3162
Mailing Address - Country:US
Mailing Address - Phone:608-334-0898
Mailing Address - Fax:
Practice Address - Street 1:20221 AURORA AVE N
Practice Address - Street 2:APT 416
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3162
Practice Address - Country:US
Practice Address - Phone:608-334-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605803761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice