Provider Demographics
NPI:1912077256
Name:CONNIE HO, MD, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CONNIE HO, MD, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-323-8900
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94302-1186
Mailing Address - Country:US
Mailing Address - Phone:650-323-8900
Mailing Address - Fax:650-323-8904
Practice Address - Street 1:882 EMERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2448
Practice Address - Country:US
Practice Address - Phone:650-323-8900
Practice Address - Fax:650-323-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ298252ZMedicare ID - Type Unspecified
CAG18886Medicare UPIN