Provider Demographics
NPI:1306038476
Name:CHO, SUSIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:J
Last Name:CHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 643141
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-8417
Mailing Address - Country:US
Mailing Address - Phone:510-543-1915
Mailing Address - Fax:213-772-6870
Practice Address - Street 1:8223 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4449
Practice Address - Country:US
Practice Address - Phone:510-543-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100620207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEM108BMedicare PIN