Provider Demographics
NPI:1952593907
Name:CHA, YUNG SOP (DDS)
Entity Type:Individual
Prefix:
First Name:YUNG
Middle Name:SOP
Last Name:CHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BELLCHASE CT
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1300
Mailing Address - Country:US
Mailing Address - Phone:410-323-2875
Mailing Address - Fax:
Practice Address - Street 1:5708 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3509
Practice Address - Country:US
Practice Address - Phone:410-323-2875
Practice Address - Fax:410-323-8961
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist