Provider Demographics
NPI:1467680165
Name:KIM, CHO LONG ELIZABETH (NMD, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:CHO LONG
Middle Name:ELIZABETH
Last Name:KIM
Suffix:
Gender:F
Credentials:NMD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3337
Mailing Address - Country:US
Mailing Address - Phone:480-584-2677
Mailing Address - Fax:
Practice Address - Street 1:5701 W CHOLLA ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3337
Practice Address - Country:US
Practice Address - Phone:562-822-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260691363LP0808X
AZ09-1122175F00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No175F00000XOther Service ProvidersNaturopath
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice