Provider Demographics
NPI:1770789307
Name:CHO, SUNG J (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:J
Last Name:CHO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 LAVENDER HILL DR STE 160-605
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2955
Mailing Address - Country:US
Mailing Address - Phone:312-371-7321
Mailing Address - Fax:
Practice Address - Street 1:10501 W GOWAN RD STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6603
Practice Address - Country:US
Practice Address - Phone:312-371-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007249103TC0700X
NVPY0975103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071007249OtherLICENSE NUMBER
406120002OtherPTAN
NVPY0975OtherLICENSE NUMBER