Healthcare Provider Details

I. General information

NPI: 1619968948
Provider Name (Legal Business Name): PETER YOUNG CHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W MARCH LN STE H
STOCKTON CA
95207-5729
US

IV. Provider business mailing address

4719 QUAIL LAKES DR G #1019
STOCKTON CA
95207
US

V. Phone/Fax

Practice location:
  • Phone: 909-254-3793
  • Fax:
Mailing address:
  • Phone: 209-565-3612
  • Fax: 707-282-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG80908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: