MEDICARE: DR. GRACE H O CHO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	35421	CA

General Provider Information

NPI Number	:	1356541080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACE H O CHO DDS

Provider Business Mailing Address
First Line	:	8215 VAN NUYS BLVD STE 220
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4836
Country	:	US
Telephone Number	:	818-782-8261
Fax Number	:	818-782-1693

Provider Business Practice Location Address
First Line	:	8215 VAN NUYS BLVD STE 220
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4836
Country	:	US
Telephone Number	:	818-782-8261
Fax Number	:	818-782-1693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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