Provider Demographics
NPI:1184762601
Name:CHO, SOON G (LAC)
Entity type:Individual
Prefix:
First Name:SOON
Middle Name:G
Last Name:CHO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:7894 DAGGET ST
Mailing Address - Street 2:SUIT 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2323
Mailing Address - Country:US
Mailing Address - Phone:858-278-7588
Mailing Address - Fax:858-278-7688
Practice Address - Street 1:7894 DAGGET ST
Practice Address - Street 2:SUIT 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2323
Practice Address - Country:US
Practice Address - Phone:858-278-7588
Practice Address - Fax:858-278-7688
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC5739171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0057390Medicaid