Provider Demographics
NPI:1043845498
Name:CHO, YOUNG MOON (DDS)
Entity type:Individual
Prefix:
First Name:YOUNG MOON
Middle Name:
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 1:469 MIGEON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4643
Mailing Address - Country:US
Mailing Address - Phone:860-489-0931
Mailing Address - Fax:
Practice Address - Street 1:469 MIGEON AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4643
Practice Address - Country:US
Practice Address - Phone:860-489-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13146122300000X
PADS042780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1043845498Medicaid