Provider Demographics
NPI:1528302387
Name:CHO, KYU OK (LAC)
Entity type:Individual
Prefix:
First Name:KYU OK
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12758 TORREY BLUFF DR
Mailing Address - Street 2:#132
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4217
Mailing Address - Country:US
Mailing Address - Phone:858-776-8655
Mailing Address - Fax:
Practice Address - Street 1:12758 TORREY BLUFF DR
Practice Address - Street 2:#132
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4217
Practice Address - Country:US
Practice Address - Phone:858-776-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist