Basic Information
| Provider Information | |||||||||
| NPI: | 1225452899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHO | ||||||||
| FirstName: | JUNGSUK | ||||||||
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| Credential: | DMD, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3223 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 TERRACE ST G32 SALK HALL | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126475815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2014 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | DS043058 | PA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.