Provider Demographics
NPI:1619968948
Name:CHO, PETER YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:YOUNG
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 1:531 TEHUACAN RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4197
Mailing Address - Country:US
Mailing Address - Phone:707-540-4707
Mailing Address - Fax:707-282-0054
Practice Address - Street 1:115 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4591
Practice Address - Country:US
Practice Address - Phone:707-463-1900
Practice Address - Fax:707-780-6375
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G809081Medicaid
CA00G809081Medicaid
CA00G809081Medicare ID - Type Unspecified