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General NPI Number Information
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NPI Number | 1376846287
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Entity Type | Individual
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Provider Name | SUSAN JENNY CHON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 1315 W MAIN AVE STE 10
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City | ALTON
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State | TX
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Zip | 78573-1643
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Country | US
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Telephone | 956-599-9446
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Fax | 956-599-9449
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Provider Business Mailing Address
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Address Line | 1315 W MAIN AVE STE 10
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City | ALTON
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State | TX
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Zip | 78573-1643
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Country | US
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Telephone | 956-599-9446
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Fax | 956-599-9449
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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 | 26163
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License Number State | TX
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