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General NPI Number Information
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NPI Number | 1821570102
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Entity Type | Organization
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Legal Business Name | LORI CHUNG CHO DMD INC.
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 150 N JACKSON AVE STE 103
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City | SAN JOSE
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State | CA
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Zip | 95116
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Country | US
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Telephone | 408-259-1004
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Fax | 408-347-1695
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Provider Business Mailing Address
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Address Line | 4393 WATSON CIR
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City | SANTA CLARA
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State | CA
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Zip | 95054-4166
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Country | US
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Telephone | 310-897-4544
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORI CHUNG CHO
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Credential | DMD
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Telephone | 310-897-4544
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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 | 47462
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License Number State | CA
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