Provider Demographics
NPI:1770740441
Name:ELSEA, MONA QUEENA CHO (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:QUEENA CHO
Last Name:ELSEA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MONA
Other - Middle Name:QUEENA
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1304 15TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1809
Mailing Address - Country:US
Mailing Address - Phone:310-393-0739
Mailing Address - Fax:
Practice Address - Street 1:1304 15TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1809
Practice Address - Country:US
Practice Address - Phone:310-393-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102272207P00000X, 207Q00000X
NY2447872083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine