Healthcare Provider Details

I. General information

NPI: 1225717549
Provider Name (Legal Business Name): HENDRICK CHO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WILSHIRE BLVD STE 100
LOS ANGELES CA
90010-1405
US

IV. Provider business mailing address

3255 WILSHIRE BLVD STE 100
LOS ANGELES CA
90010-1405
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: