Provider Demographics
NPI:1053381996
Name:CHO, SUNG Y (DDS)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:Y
Last Name:CHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 E TUDOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1128
Mailing Address - Country:US
Mailing Address - Phone:907-677-1212
Mailing Address - Fax:907-677-1247
Practice Address - Street 1:2421 E TUDOR RD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1128
Practice Address - Country:US
Practice Address - Phone:907-677-1212
Practice Address - Fax:907-677-1247
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD57371Medicaid
AK56-2609329OtherTAX ID