Provider Demographics
NPI:1730217985
Name:CHO, KI CHUL (LAC,ND)
Entity type:Individual
Prefix:
First Name:KI
Middle Name:CHUL
Last Name:CHO
Suffix:
Gender:M
Credentials:LAC,ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-260-1188
Mailing Address - Fax:408-554-1470
Practice Address - Street 1:2454 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-260-1188
Practice Address - Fax:408-554-1470
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0057550171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist