Provider Demographics
NPI:1427220029
Name:CHO, SUNG HEE (DDS, MD)
Entity Type:Individual
Prefix:
First Name:SUNG HEE
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KINDERKAMACK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1931
Mailing Address - Country:US
Mailing Address - Phone:210-487-6565
Mailing Address - Fax:
Practice Address - Street 1:130 KINDERKAMACK RD STE 204
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1931
Practice Address - Country:US
Practice Address - Phone:210-487-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135721223S0112X
GA68711204E00000X
NJ25MA09486700204E00000X
NJ22DI025636001223S0112X
NY274404204E00000X
NY0571281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery