Provider Demographics
NPI:1851445357
Name:CHO, KYU SOON (OMD)
Entity Type:Individual
Prefix:DR
First Name:KYU
Middle Name:SOON
Last Name:CHO
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 SOUTH ST
Mailing Address - Street 2:#109
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-7053
Mailing Address - Country:US
Mailing Address - Phone:562-924-0723
Mailing Address - Fax:
Practice Address - Street 1:12225 SOUTH ST
Practice Address - Street 2:#109
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7053
Practice Address - Country:US
Practice Address - Phone:562-924-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3180171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0031800Medicaid