Provider Demographics
NPI:1780935114
Name:CHO, DAEHYUN P (PEER SPECIALIST)
Entity type:Individual
Prefix:
First Name:DAEHYUN
Middle Name:P
Last Name:CHO
Suffix:
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3801
Mailing Address - Country:US
Mailing Address - Phone:213-480-1557
Mailing Address - Fax:
Practice Address - Street 1:560 S. ST. LOUIS LOS ANGELES, CA 90033
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3801
Practice Address - Country:US
Practice Address - Phone:213-480-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator