Provider Demographics
NPI:1316396203
Name:CHO, KYUNG (DDS)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 EMMETT ST W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2963
Mailing Address - Country:US
Mailing Address - Phone:269-965-8866
Mailing Address - Fax:
Practice Address - Street 1:4500 SAND POINT WAY NE STE 212
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3925
Practice Address - Country:US
Practice Address - Phone:206-524-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60989074122300000X
MI2901021937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist