Provider Demographics
NPI:1275822165
Name:CHO, HYUNCHANG
Entity Type:Individual
Prefix:
First Name:HYUNCHANG
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 1:2656 FAIRWAY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1485
Mailing Address - Country:US
Mailing Address - Phone:818-249-9627
Mailing Address - Fax:
Practice Address - Street 1:11440 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3154
Practice Address - Country:US
Practice Address - Phone:818-985-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist