Healthcare Provider Details

I. General information

NPI: 1386843894
Provider Name (Legal Business Name): SUNGEYUN DAVID CHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SE SUNNYSIDE RD DEPT OF SURGERY
CLACKAMAS OR
97015-9777
US

IV. Provider business mailing address

9900 SE SUNNYSIDE RD DEPT OF SURGERY
CLACKAMAS OR
97015-9777
US

V. Phone/Fax

Practice location:
  • Phone: 503-813-2000
  • Fax:
Mailing address:
  • Phone: 503-813-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL16897
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD60540689
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD154771
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: