Provider Demographics
NPI:1033306626
Name:HO, TAE CHUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAE CHUL
Middle Name:
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 1:288 W 238TH ST
Mailing Address - Street 2:APT. 6D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2314
Mailing Address - Country:US
Mailing Address - Phone:917-687-4425
Mailing Address - Fax:
Practice Address - Street 1:3744 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2102
Practice Address - Country:US
Practice Address - Phone:718-590-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57282701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02888493Medicaid