Provider Demographics
NPI: | 1750848537 |
---|---|
Name: | CHO DENTAL CORPORATION |
Entity Type: | Organization |
Organization Name: | CHO DENTAL CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUNG |
Authorized Official - Middle Name: | Y |
Authorized Official - Last Name: | CHO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 925-915-9042 |
Mailing Address - Street 1: | 1523 E MARCH LN STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | STOCKTON |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95210-5607 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 209-323-6933 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3605 HOSPITAL RD STE H |
Practice Address - Street 2: | |
Practice Address - City: | ATWATER |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95301-5173 |
Practice Address - Country: | US |
Practice Address - Phone: | 209-381-2047 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CHO DENTAL CORPORATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-02-27 |
Last Update Date: | 2019-03-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty | |
No | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |