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NPI Code Detail

MEDICARE: HENRY KWANG-SUK CHO D.M.D

MEDICARE: HENRY KWANG-SUK CHO D.M.D
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
1122300000XDentist019027691IL

General Provider Information

NPI Number : 1871731430
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY KWANG-SUK CHO D.M.D
Provider Business Mailing Address
First Line : 3 THE COURT OF OVERLOOK BLF
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-3213
Country : US
Telephone Number : 224-324-2242
Fax Number :
Provider Business Practice Location Address
First Line : 2821 GRAND AVE
Second Line :
City : WAUKEGAN
State : IL
Zip : 60085-2372
Country : US
Telephone Number : 847-662-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2009
Last Update Date : 01/16/2013

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