Provider Demographics
NPI:1003839960
Name:CHO, THEODORE CHUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:CHUNG
Last Name:CHO
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 1:175 N MILWAUKEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4302
Mailing Address - Country:US
Mailing Address - Phone:847-955-9500
Mailing Address - Fax:847-955-9519
Practice Address - Street 1:175 N MILWAUKEE AVE STE 200
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4302
Practice Address - Country:US
Practice Address - Phone:847-955-9500
Practice Address - Fax:847-955-9519
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice