Provider Demographics
NPI:1508427311
Name:CHO, JAEYEON (DMD)
Entity Type:Individual
Prefix:
First Name:JAEYEON
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 NORTHWOOD HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1747
Mailing Address - Country:US
Mailing Address - Phone:832-638-9428
Mailing Address - Fax:
Practice Address - Street 1:6302 BROADWAY ST STE 150
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7828
Practice Address - Country:US
Practice Address - Phone:281-971-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist