Provider Demographics
NPI:1114111820
Name:CHO, PHILLIP SUNGWOON (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SUNGWOON
Last Name:CHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SUNG WOON
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:56969 YUCCA TRL STE C
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3797
Mailing Address - Country:US
Mailing Address - Phone:760-228-1733
Mailing Address - Fax:760-365-9123
Practice Address - Street 1:56969 YUCCA TRL STE C
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3797
Practice Address - Country:US
Practice Address - Phone:760-228-1733
Practice Address - Fax:760-365-9123
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice