Healthcare Provider Details

I. General information

NPI: 1710029657
Provider Name (Legal Business Name): CHEN NAN HO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30979 ROAD 67
GOSHEN CA
93291-9303
US

IV. Provider business mailing address

24863 W JAYNE AVE BOX 8500
COALINGA CA
93210-9502
US

V. Phone/Fax

Practice location:
  • Phone: 559-651-2301
  • Fax: 559-651-1584
Mailing address:
  • Phone: 559-935-4900
  • Fax: 559-935-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number223548695
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021737
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA110971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: