Provider Demographics
NPI:1306940036
Name:CHO, DONG SIK (MD)
Entity type:Individual
Prefix:
First Name:DONG
Middle Name:SIK
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ROBIN AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5772
Mailing Address - Country:US
Mailing Address - Phone:985-230-1860
Mailing Address - Fax:985-230-1861
Practice Address - Street 1:2101 ROBIN AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5772
Practice Address - Country:US
Practice Address - Phone:985-230-1860
Practice Address - Fax:985-230-1861
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071513A208100000X
AK5476208100000X
TXP5608208100000X
LA300435208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0546Medicaid
LA2407431Medicaid
P00175198Medicare PIN
LA2407431Medicaid
AKMD0546Medicaid
D25223Medicare UPIN