Provider Demographics
NPI:1740471218
Name:CHO, SANGSOO (FNP)
Entity type:Individual
Prefix:MRS
First Name:SANGSOO
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9335 PEARSALL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-7436
Mailing Address - Country:US
Mailing Address - Phone:713-269-1008
Mailing Address - Fax:
Practice Address - Street 1:31303 FM 2920 RD
Practice Address - Street 2:G
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8197
Practice Address - Country:US
Practice Address - Phone:936-931-3448
Practice Address - Fax:936-931-3704
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2035487-02Medicaid
TXD07564OtherMEDICARE PALMETTO RR
TX2862377-01Medicaid
TXP01002177OtherMEDICARE PALMETTO RR
TXD07564OtherMEDICARE PALMETTO RR
TXTXB102731Medicare PIN
TXTXB140895Medicare PIN