Healthcare Provider Details

I. General information

NPI: 1245845825
Provider Name (Legal Business Name): JAEHUN CHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 N LAKE AVE
PASADENA CA
91104-3768
US

IV. Provider business mailing address

2801 SUNSET PL APT 2202
LOS ANGELES CA
90005-4535
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-1800
  • Fax:
Mailing address:
  • Phone: 628-224-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS105325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: