Provider Demographics
NPI:1821570102
Name:LORI CHUNG CHO DMD INC.
Entity Type:Organization
Organization Name:LORI CHUNG CHO DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:CHUNG
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-897-4544
Mailing Address - Street 1:4393 WATSON CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-4166
Mailing Address - Country:US
Mailing Address - Phone:310-897-4544
Mailing Address - Fax:
Practice Address - Street 1:150 N JACKSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-259-1004
Practice Address - Fax:408-347-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-03
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47462261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental