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General NPI Number Information
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NPI Number | 1689166084
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Entity Type | Organization
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Legal Business Name | M. CHO, DDS, PLLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 12644 164TH AVE SE
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City | RENTON
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State | WA
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Zip | 98059-6403
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Country | US
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Telephone | 425-282-4182
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 118TH AVE SE APT 102
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City | BELLEVUE
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State | WA
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Zip | 98005-8130
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Country | US
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Telephone | 909-362-6319
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MICHAEL SUNGYUN CHO
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Credential | DDS
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Telephone | 909-362-6319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60603860
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License Number State | WA
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