Provider Demographics
NPI:1881387066
Name:CHO, JAE EUN (DMD)
Entity type:Individual
Prefix:
First Name:JAE EUN
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JAE
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:6964 W MEADOW GRASS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1783
Mailing Address - Country:US
Mailing Address - Phone:801-616-8910
Mailing Address - Fax:
Practice Address - Street 1:2524 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-1247
Practice Address - Country:US
Practice Address - Phone:801-982-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13396333-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist