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General NPI Number Information
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NPI Number | 1619386174
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Entity Type | Individual
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Provider Name | HYUNBAE CHO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 6115 PACIFIC BLVD
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2922
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Country | US
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Telephone | 323-586-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 260 HILLSIDE RD
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-1612
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 057355
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License Number State | NY
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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 | 64165
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License Number State | CA
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