Healthcare Provider Details

I. General information

NPI: 1699096180
Provider Name (Legal Business Name): RYAN SUNG-EUN CHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MEDICAL PKWY STE 200
CEDAR PARK TX
78613-2778
US

IV. Provider business mailing address

1411 MEDICAL PKWY STE 200
CEDAR PARK TX
78613-2778
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-0900
  • Fax: 512-341-2895
Mailing address:
  • Phone: 512-341-0900
  • Fax: 512-341-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS4743
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberS4743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: