Provider Demographics
NPI:1225171028
Name:CHO, BYUNG GAB (LAC)
Entity Type:Individual
Prefix:
First Name:BYUNG
Middle Name:GAB
Last Name:CHO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SE OAK ST STE K
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4245
Mailing Address - Country:US
Mailing Address - Phone:503-430-1057
Mailing Address - Fax:503-430-1085
Practice Address - Street 1:730 SE OAK ST STE K
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4245
Practice Address - Country:US
Practice Address - Phone:503-430-1057
Practice Address - Fax:503-430-1085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11300171100000X
ORAC152667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist