Provider Demographics
NPI:1952432049
Name:CHO, HAE-KYUNG (RN, NP)
Entity Type:Individual
Prefix:
First Name:HAE-KYUNG
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:HAE
Other - Middle Name:K
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN,NP
Mailing Address - Street 1:1284 1/2 S BEVERLY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5260
Mailing Address - Country:US
Mailing Address - Phone:310-801-7452
Mailing Address - Fax:
Practice Address - Street 1:3699 WILSHIRE BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2719
Practice Address - Country:US
Practice Address - Phone:323-783-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN516119, NP11503363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ21651Medicare UPIN