1760647010 NPI number — WHAN MICHAEL CHO DDS PS

Table of content: (NPI 1760647010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760647010 NPI number — WHAN MICHAEL CHO DDS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHAN MICHAEL CHO DDS PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760647010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11605 STATE AVE
Provider Second Line Business Mailing Address:
STE. 108
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98271-8427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-386-9540
Provider Business Mailing Address Fax Number:
360-386-9542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11605 STATE AVE
Provider Second Line Business Practice Location Address:
STE. 108
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98271-8427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-386-9540
Provider Business Practice Location Address Fax Number:
360-386-9542
Provider Enumeration Date:
07/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHO
Authorized Official First Name:
WHAN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-386-9540

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00010468 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DE00010468 . This is a "DENTAL LISENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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