Healthcare Provider Details

I. General information

NPI: 1245899095
Provider Name (Legal Business Name): EUN JUNG CHO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32144 AGOURA RD STE 216
WESTLAKE VILLAGE CA
91361-4055
US

IV. Provider business mailing address

32144 AGOURA RD STE 216
WESTLAKE VILLAGE CA
91361-4055
US

V. Phone/Fax

Practice location:
  • Phone: 818-991-0978
  • Fax:
Mailing address:
  • Phone: 818-991-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number106186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: