Provider Demographics
NPI:1912319302
Name:CHO, JASON JAISUNG (DDS, MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JAISUNG
Last Name:CHO
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 48TH ST RM 1502
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1095
Mailing Address - Country:US
Mailing Address - Phone:530-848-2075
Mailing Address - Fax:
Practice Address - Street 1:18 E 48TH ST RM 1502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1095
Practice Address - Country:US
Practice Address - Phone:530-848-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN249401223S0112X
NY0630911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery