Basic Information
Provider Information
NPI: 1861948382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHO
FirstName: SOUNG
MiddleName: HA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 635283
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452635283
CountryCode: US
TelephoneNumber: 8593445555
FaxNumber: 8593445552
Practice Location
Address1: 4900 HOUSTON RD
Address2:  
City: FLORENCE
State: KY
PostalCode: 41042
CountryCode: US
TelephoneNumber: 8593018074
FaxNumber: 8593014945
Other Information
ProviderEnumerationDate: 08/26/2016
LastUpdateDate: 02/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X52456KYY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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