Provider Demographics
NPI:1245909001
Name:PHILLIP SUNG W CHO DENTAL CORP
Entity type:Organization
Organization Name:PHILLIP SUNG W CHO DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:SUNGWOON
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-557-0912
Mailing Address - Street 1:56969 YUCCA TRL STE C
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3797
Mailing Address - Country:US
Mailing Address - Phone:760-228-1733
Mailing Address - Fax:760-365-9123
Practice Address - Street 1:56969 YUCCA TRL STE C
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3797
Practice Address - Country:US
Practice Address - Phone:760-228-1733
Practice Address - Fax:760-365-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental