Provider Demographics
NPI:1629118674
Name:CHO, CYNTHIA Y (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:Y
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 1:1995 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6301
Mailing Address - Country:US
Mailing Address - Phone:323-264-2500
Mailing Address - Fax:323-268-7232
Practice Address - Street 1:1995 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6301
Practice Address - Country:US
Practice Address - Phone:323-264-2500
Practice Address - Fax:323-268-7232
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9370601OtherDENTICAL