Provider Demographics
NPI:1629161146
Name:HO, CHAO
Entity Type:Individual
Prefix:DR
First Name:CHAO
Middle Name:
Last Name:HO
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 1:13847 EAST 14TH STREET
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94564
Mailing Address - Country:US
Mailing Address - Phone:510-618-1663
Mailing Address - Fax:510-618-1611
Practice Address - Street 1:13847 EAST 14TH STREET
Practice Address - Street 2:SUITE 113
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-618-1663
Practice Address - Fax:510-618-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559870Medicaid
CA00A559870Medicaid
CAG51256Medicare UPIN