Healthcare Provider Details

I. General information

NPI: 1750848537
Provider Name (Legal Business Name): CHO DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 HOSPITAL RD STE H
ATWATER CA
95301-5173
US

IV. Provider business mailing address

1523 E MARCH LN STE A
STOCKTON CA
95210-5607
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-2047
  • Fax:
Mailing address:
  • Phone: 209-323-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SUNG Y CHO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 925-915-9042