MEDICARE: JOOWON CHO DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1720625106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOOWON CHO DDS PLLC

Provider Business Mailing Address
First Line	:	10700 ANDERSON MILL RD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-2402
Country	:	US
Telephone Number	:	512-666-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 ANDERSON MILL RD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-2402
Country	:	US
Telephone Number	:	512-666-4407
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	JOO WON CHO
Credential	:	DDS
Telephone Number	:	512-666-4407

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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