Provider Demographics
NPI:1710592217
Name:CHO, DUCK (MC#9064)
Entity Type:Individual
Prefix:
First Name:DUCK
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:MC#9064
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 RADIANCE BLVD E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3822
Mailing Address - Country:US
Mailing Address - Phone:253-228-9982
Mailing Address - Fax:253-926-4395
Practice Address - Street 1:6410 RADIANCE BLVD E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-3822
Practice Address - Country:US
Practice Address - Phone:253-228-9982
Practice Address - Fax:253-926-4395
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60271212351171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter