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General NPI Number Information
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NPI Number | 1245845825
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Entity Type | Individual
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Provider Name | JAEHUN CHO
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Gender | Male
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 599 INLAND CENTER DR STE 110
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1819
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Country | US
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Telephone | 628-224-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 599 INLAND CENTER DR STE 110
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1819
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Country | US
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Telephone | 628-224-1560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS105325
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License Number State | CA
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