Provider Demographics
NPI:1942336995
Name:CHI, CHING-ROO (DDS, BDS)
Entity Type:Individual
Prefix:DR
First Name:CHING-ROO
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:DDS, BDS
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:CHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, BDS
Mailing Address - Street 1:473 E ALLESSANDRO BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508
Mailing Address - Country:US
Mailing Address - Phone:951-789-6886
Mailing Address - Fax:951-780-1998
Practice Address - Street 1:473 E. ALLESSANDRO BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508
Practice Address - Country:US
Practice Address - Phone:951-789-6886
Practice Address - Fax:951-780-1998
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40066OtherLIC. #
CABC341522OtherDEA#