Provider Demographics
NPI:1043222664
Name:CHO, KYUNGJA KAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYUNGJA
Middle Name:KAY
Last Name:CHO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KYUNG
Other - Middle Name:JA
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2821 SW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2605
Mailing Address - Country:US
Mailing Address - Phone:405-692-7333
Mailing Address - Fax:405-692-7336
Practice Address - Street 1:2821 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2605
Practice Address - Country:US
Practice Address - Phone:405-692-7333
Practice Address - Fax:405-692-7336
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice