Provider Demographics
NPI:1376601112
Name:CHA, SUNG YUP JEROME (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUNG YUP JEROME
Middle Name:
Last Name:CHA
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 1:9445 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5792
Mailing Address - Country:US
Mailing Address - Phone:918-496-1919
Mailing Address - Fax:918-496-1584
Practice Address - Street 1:9445 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5792
Practice Address - Country:US
Practice Address - Phone:918-496-1919
Practice Address - Fax:918-496-1584
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist