Provider Demographics
NPI:1427473719
Name:CHO, ADRIAN YONGTAE
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:YONGTAE
Last Name:CHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YONG TAE
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:198 E ELM AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-2837
Mailing Address - Country:US
Mailing Address - Phone:559-935-2368
Mailing Address - Fax:
Practice Address - Street 1:198 E ELM AVE STE 103
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2837
Practice Address - Country:US
Practice Address - Phone:213-393-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist