Provider Demographics
NPI:1730836099
Name:CHO, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SAN MATEO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-7172
Mailing Address - Country:US
Mailing Address - Phone:646-417-2994
Mailing Address - Fax:
Practice Address - Street 1:210 SAN MATEO RD STE 104
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7172
Practice Address - Country:US
Practice Address - Phone:650-726-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA$$$$$$$$$1223G0001X
CA109407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice