Active NPI
Jeong Rae Cho, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- West Haven, CT
National Provider Identifier
1235567173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 10702
- Practice address
- 666 Campbell Ave
West Haven, CT 06516-3775 - Phone
- (203) 889-2611
- Fax
- (203) 823-9072
- NPI assigned
- Oct 30, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 10702 | CT | Primary |
Addresses
Primary practice location
666 Campbell Ave
West Haven, CT 06516-3775
Mailing address
666 Campbell Ave
West Haven, CT 06516-3775
Phone (203) 889-2611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10702 | CT | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393545600000",
"number": "1235567173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "666 CAMPBELL AVE",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065163775",
"telephone_number": "203-889-2611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "666 CAMPBELL AVE",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065163775",
"telephone_number": "203-889-2611",
"fax_number": "203-823-9072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHO",
"first_name": "JEONG RAE",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-10-30",
"last_updated": "2014-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CT",
"license": "10702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.