Healthcare Provider Details

I. General information

NPI: 1366011421
Provider Name (Legal Business Name): SUNG YONG CHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E BIDWELL ST STE 9
FOLSOM CA
95630-3315
US

IV. Provider business mailing address

705 E BIDWELL ST STE 9
FOLSOM CA
95630-3315
US

V. Phone/Fax

Practice location:
  • Phone: 916-908-4777
  • Fax:
Mailing address:
  • Phone: 916-908-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: