Provider Demographics
NPI:1487883658
Name:HANSON, JINNY CHO (DDS)
Entity type:Individual
Prefix:DR
First Name:JINNY
Middle Name:CHO
Last Name:HANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 WYLDE GREEN RD
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4828
Mailing Address - Country:US
Mailing Address - Phone:319-594-4482
Mailing Address - Fax:
Practice Address - Street 1:1700 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2033
Practice Address - Country:US
Practice Address - Phone:319-396-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice