Provider Demographics
NPI:1306278486
Name:CHO, HANJIN (DDS)
Entity type:Individual
Prefix:DR
First Name:HANJIN
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LUKE
Other - Middle Name:HANJIN
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2992 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4226
Mailing Address - Country:US
Mailing Address - Phone:917-224-4984
Mailing Address - Fax:
Practice Address - Street 1:2992 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4226
Practice Address - Country:US
Practice Address - Phone:917-224-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11023122300000X
CT0110231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist