Provider Demographics
NPI:1861460073
Name:CHO, CHUNG (MD)
Entity Type:Individual
Prefix:
First Name:CHUNG
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 1:372 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2305
Mailing Address - Country:US
Mailing Address - Phone:914-591-8907
Mailing Address - Fax:
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3124
Practice Address - Country:US
Practice Address - Phone:718-430-7472
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314461Medicaid
NY34219Medicare ID - Type Unspecified
NY00314461Medicaid