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General NPI Number Information
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NPI Number | 1407558109
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Entity Type | Individual
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Provider Name | RENNY CHO DDS
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Gender | Male
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 400 S TOWNLINE RD
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City | WAUTOMA
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State | WI
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Zip | 54982-6922
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Country | US
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Telephone | 180-833-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 51 MCARTHUR AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-1924
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Country | US
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Telephone | 917-836-1730
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6001632
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License Number State | WI
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