Provider Demographics
NPI:1083699839
Name:HO, CHUN WAH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUN WAH
Middle Name:
Last Name:HO
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 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-322-8460
Mailing Address - Fax:520-322-5742
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:#251
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-322-8460
Practice Address - Fax:520-322-5742
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ338542Medicaid
28673Medicare ID - Type Unspecified
G11987Medicare UPIN