Provider Demographics
NPI:1588731509
Name:CHO, JAMES KYONG (RPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KYONG
Last Name:CHO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12627 SANTA GERTRUDES AVE
Mailing Address - Street 2:STE E
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2533
Mailing Address - Country:US
Mailing Address - Phone:562-902-6033
Mailing Address - Fax:562-902-6092
Practice Address - Street 1:1053 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1940
Practice Address - Country:US
Practice Address - Phone:323-933-2784
Practice Address - Fax:323-933-2786
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26577208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26577BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER