Provider Demographics
NPI:1063647386
Name:CHO, SEONG CHAN
Entity Type:Individual
Prefix:
First Name:SEONG CHAN
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13618 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2943
Mailing Address - Country:US
Mailing Address - Phone:718-463-8885
Mailing Address - Fax:718-463-8884
Practice Address - Street 1:13618 35TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2943
Practice Address - Country:US
Practice Address - Phone:718-463-8885
Practice Address - Fax:718-463-8884
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist