Provider Demographics
NPI:1427668672
Name:CHO, SE HOON
Entity type:Individual
Prefix:
First Name:SE
Middle Name:HOON
Last Name:CHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SIMON
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2268 W 20TH ST #2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1412
Mailing Address - Country:US
Mailing Address - Phone:213-291-4840
Mailing Address - Fax:
Practice Address - Street 1:2268 W 20TH ST #2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1412
Practice Address - Country:US
Practice Address - Phone:213-291-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6S70149172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver