=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639421951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SSCL CORP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2012
-----------------------------------------------------
Last Update Date | 09/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1315 W. MAIN AVE STE 10
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-599-9446
-----------------------------------------------------
Fax | 956-599-9449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1315 W. MAIN AVE STE 10
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-599-9446
-----------------------------------------------------
Fax | 956-599-9449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. YOJIN STEVEN CHON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 956-599-9446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 26156
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------