Provider Demographics
NPI:1699220160
Name:CHO, EUN YOUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUN YOUNG
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EUN YOUNG
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4115 23RD ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1027 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5818
Practice Address - Country:US
Practice Address - Phone:347-507-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1006771223G0001X
TX319671223G0001X
NY0602331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice