Provider Demographics
NPI:1902867187
Name:CHAN, JOHOL CHO-HONG (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHOL
Middle Name:CHO-HONG
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450193
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0004
Mailing Address - Country:US
Mailing Address - Phone:956-795-8236
Mailing Address - Fax:956-718-6994
Practice Address - Street 1:219 N SANBORN RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2218
Practice Address - Country:US
Practice Address - Phone:831-757-1365
Practice Address - Fax:831-757-2824
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL6214207V00000X
TXK1389207V00000X
ORDO198325207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00691823OtherPALMETTO GBA (MEDICARE RAILROAD)
TX101708906Medicaid
TX101708906Medicaid