Provider Demographics
NPI:1376767194
Name:CHO, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CHO
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:PO BOX 14005
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-1405
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:431 S BATAVIA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3936
Practice Address - Country:US
Practice Address - Phone:714-538-6731
Practice Address - Fax:714-771-8369
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA845632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A845630OtherBLUE SHIELD
CA00A845630Medicaid
CA00A845630Medicaid
CA00A845632Medicare PIN
I74306Medicare UPIN
CA00A845633Medicare PIN
CA00A845635Medicare PIN