Healthcare Provider Details

I. General information

NPI: 1679493001
Provider Name (Legal Business Name): ALYSSA K CHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 JUANITA LN
TIBURON CA
94920-2548
US

IV. Provider business mailing address

99 OCEAN AVENUE 208
SAN FRANCISCO CA
94112
US

V. Phone/Fax

Practice location:
  • Phone: 415-435-3371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: