Provider Demographics
NPI:1124183777
Name:CHO, IAN IKHYUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:IKHYUN
Last Name:CHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7067 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5311
Mailing Address - Country:US
Mailing Address - Phone:520-721-8011
Mailing Address - Fax:520-721-8015
Practice Address - Street 1:7067 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5311
Practice Address - Country:US
Practice Address - Phone:520-721-8011
Practice Address - Fax:520-721-8015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD55051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice