Provider Demographics
NPI:1053512566
Name:CHO, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S VIRGIL AVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1406
Mailing Address - Country:US
Mailing Address - Phone:213-674-8282
Mailing Address - Fax:213-232-7013
Practice Address - Street 1:505 S VIRGIL AVE
Practice Address - Street 2:STE. 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1406
Practice Address - Country:US
Practice Address - Phone:213-674-8282
Practice Address - Fax:213-232-7013
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75694207R00000X
NV13530207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1053512566Medicaid
NVDP081ZMedicare PIN