Healthcare Provider Details

I. General information

NPI: 1104379692
Provider Name (Legal Business Name): SUSAN CHO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 SEPULVEDA BLVD
CULVER CITY CA
90230-4605
US

IV. Provider business mailing address

3861 SEPULVEDA BLVD
CULVER CITY CA
90230-4605
US

V. Phone/Fax

Practice location:
  • Phone: 310-450-2191
  • Fax: 310-450-0873
Mailing address:
  • Phone: 310-450-2191
  • Fax: 310-450-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95006724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: