Provider Demographics
NPI:1366832644
Name:CHO, JI YOUN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JI YOUN
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N BEAUDRY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2009
Mailing Address - Country:US
Mailing Address - Phone:213-202-7533
Mailing Address - Fax:213-580-6557
Practice Address - Street 1:121 N BEAUDRY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2009
Practice Address - Country:US
Practice Address - Phone:213-202-7533
Practice Address - Fax:213-580-6557
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23674363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics