Provider Demographics
NPI:1578008363
Name:CHO, YU RI (LD/ DPD)
Entity Type:Individual
Prefix:
First Name:YU RI
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:LD/ DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 PACIFIC AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7836
Mailing Address - Country:US
Mailing Address - Phone:532-328-4986
Mailing Address - Fax:
Practice Address - Street 1:3716 PACIFIC AVE
Practice Address - Street 2:SUITE H
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7836
Practice Address - Country:US
Practice Address - Phone:240-477-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENR.DN.60592834122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1578008363Medicaid