Provider Demographics
NPI:1598147506
Name:CHO, JESSICA JUNGKYUNG (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JUNGKYUNG
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 1:2433 W TRANSIT AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2219
Mailing Address - Country:US
Mailing Address - Phone:714-686-7880
Mailing Address - Fax:
Practice Address - Street 1:50 S ANAHEIM BLVD
Practice Address - Street 2:SUITE #94
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2931
Practice Address - Country:US
Practice Address - Phone:714-635-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA100661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program