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General NPI Number Information
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NPI Number | 1104314095
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Entity Type | Organization
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Legal Business Name | CHANG-HO CHON, DO AND TELIANNE CHON, DO, INC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 4234 RIVERWALK PKWY STE 140
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City | RIVERSIDE
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State | CA
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Zip | 92505-3304
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Country | US
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Telephone | 951-688-8060
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Fax | 951-688-8070
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Provider Business Mailing Address
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Address Line | 4234 RIVERWALK PKWY STE 140
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City | RIVERSIDE
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State | CA
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Zip | 92505-3304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHANG-HO L CHON
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Credential | DO
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Telephone | 909-466-9690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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