Provider Demographics
NPI:1225133846
Name:KOH, CHESTER JUNGDON (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:JUNGDON
Last Name:KOH
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 1:6701 FANNIN ST
Mailing Address - Street 2:CCC, SUITE 620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2608
Mailing Address - Country:US
Mailing Address - Phone:832-822-3160
Mailing Address - Fax:832-825-3159
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:CCC, SUITE 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-822-3160
Practice Address - Fax:832-825-3159
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83920208800000X
TXP7138208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A637070Medicaid
CA00A637070Medicaid
CAWG63707AMedicare ID - Type Unspecified