Healthcare Provider Details

I. General information

NPI: 1568479947
Provider Name (Legal Business Name): CHO CHO HAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

IV. Provider business mailing address

5772 228TH ST FLOOR 1
OAKLAND GARDENS NY
11364-2439
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-318-4809
Mailing address:
  • Phone: 718-225-2572
  • Fax: 718-225-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number204150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: