MEDICARE: DR. KYUNGJA KAY CHO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5407	OK

General Provider Information

NPI Number	:	1043222664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYUNGJA KAY CHO DMD

Provider Business Mailing Address
First Line	:	2821 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-692-7333
Fax Number	:	405-692-7336

Provider Business Practice Location Address
First Line	:	2821 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-692-7333
Fax Number	:	405-692-7336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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