Provider Demographics
NPI:1205212420
Name:CHO, ANNA SELENA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:SELENA
Last Name:CHO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 PIER AVE.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5311
Mailing Address - Country:US
Mailing Address - Phone:310-880-3825
Mailing Address - Fax:
Practice Address - Street 1:169 PIER AVE.
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5311
Practice Address - Country:US
Practice Address - Phone:310-880-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012756103T00000X
CA106H00000X
CA99936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA83-3420148Medicaid