Provider Demographics
NPI:1124659750
Name:CHO, JANE KIM
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:KIM
Last Name:CHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5071 ST ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0606
Mailing Address - Country:US
Mailing Address - Phone:909-576-7110
Mailing Address - Fax:
Practice Address - Street 1:5071 ST ALBERT DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0606
Practice Address - Country:US
Practice Address - Phone:909-576-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist