Provider Demographics
NPI:1508319153
Name:CHO, MIN JEONG (DDS)
Entity Type:Individual
Prefix:
First Name:MIN JEONG
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 1:3250 MARKET ST APT 228
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2465
Mailing Address - Country:US
Mailing Address - Phone:214-843-7989
Mailing Address - Fax:
Practice Address - Street 1:2019 N RIVERSIDE AVE # C
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377
Practice Address - Country:US
Practice Address - Phone:909-877-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320791223G0001X
CA1036151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice