Provider Demographics
NPI:1629649462
Name:CHO, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 N MAIN ST UNIT 506
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4199
Mailing Address - Country:US
Mailing Address - Phone:707-845-9128
Mailing Address - Fax:
Practice Address - Street 1:1855 SAN MIGUEL DR STE 20
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5290
Practice Address - Country:US
Practice Address - Phone:925-934-3892
Practice Address - Fax:925-934-3606
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1061541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics