Provider Demographics
NPI:1750581369
Name:PETER Y CHO MD INC
Entity type:Organization
Organization Name:PETER Y CHO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-463-1900
Mailing Address - Street 1:115 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4591
Mailing Address - Country:US
Mailing Address - Phone:707-463-1900
Mailing Address - Fax:707-780-6375
Practice Address - Street 1:115 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4591
Practice Address - Country:US
Practice Address - Phone:707-463-1900
Practice Address - Fax:707-780-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIA82325OtherLICENSE
CA1619968948Medicaid
CA00G809081Medicaid
CAG80908OtherLICENSE
CA1619968948Medicaid
CA00G809081Medicaid