Healthcare Provider Details

I. General information

NPI: 1770740441
Provider Name (Legal Business Name): MONA QUEENA CHO ELSEA M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONA QUEENA CHO MD

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 15TH ST SUITE 202
SANTA MONICA CA
90404-1809
US

IV. Provider business mailing address

1304 15TH ST SUITE 202
SANTA MONICA CA
90404-1809
US

V. Phone/Fax

Practice location:
  • Phone: 310-393-0739
  • Fax:
Mailing address:
  • Phone: 310-393-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA102272
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number244787
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA102272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: