=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801401542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOJEONG CHO DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2020
-----------------------------------------------------
Last Update Date | 02/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 S ALAMEDA ST STE 213
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013-1734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-554-5230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 S ALAMEDA ST STE 213
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013-1734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-554-5230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 105463
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------