Provider Demographics
NPI:1245917731
Name:CHO, GIYONG (DMD)
Entity type:Individual
Prefix:
First Name:GIYONG
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W BEVERLY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3660
Mailing Address - Country:US
Mailing Address - Phone:323-721-9777
Mailing Address - Fax:
Practice Address - Street 1:600 W BEVERLY BLVD STE B
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3660
Practice Address - Country:US
Practice Address - Phone:323-721-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1088511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty