Healthcare Provider Details

I. General information

NPI: 1366461899
Provider Name (Legal Business Name): TAE-UK CHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL SUITE B260A
SIERRA VISTA AZ
85635-2967
US

IV. Provider business mailing address

77 CALLE PORTAL SUITE B260A
SIERRA VISTA AZ
85635-2967
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-9751
  • Fax: 520-515-9786
Mailing address:
  • Phone: 520-515-9751
  • Fax: 520-515-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberAZ14080
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: