Healthcare Provider Details

I. General information

NPI: 1962920561
Provider Name (Legal Business Name): EUGENIE CHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2017
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 E GREEN ST APT 2311
PASADENA CA
91101-2322
US

IV. Provider business mailing address

2888 LONG BEACH BLVD STE 165
LONG BEACH CA
90806-1561
US

V. Phone/Fax

Practice location:
  • Phone: 678-799-0114
  • Fax:
Mailing address:
  • Phone: 657-241-9052
  • Fax: 714-665-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: