1740471218 NPI number — MRS. SANGSOO CHO FNP

Table of content: MRS. SANGSOO CHO FNP (NPI 1740471218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740471218 NPI number — MRS. SANGSOO CHO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHO
Provider First Name:
SANGSOO
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740471218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9335 PEARSALL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77064-7436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-269-1008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31303 FM 2920 RD
Provider Second Line Business Practice Location Address:
G
Provider Business Practice Location Address City Name:
WALLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77484-8197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-931-3448
Provider Business Practice Location Address Fax Number:
936-931-3704
Provider Enumeration Date:
08/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  619494 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2035487-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: D07564 . This is a "MEDICARE PALMETTO RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2862377-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01002177 . This is a "MEDICARE PALMETTO RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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