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General NPI Number Information
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NPI Number | 1104561398
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Entity Type | Individual
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Provider Name | JESSE CHO
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Gender | Male
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 900 FIR ST
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City | LONGVIEW
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State | WA
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Zip | 98632-2544
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Country | US
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Telephone | 949-878-8315
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Fax | 360-353-9441
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Provider Business Mailing Address
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Address Line | PO BOX 2429
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City | LONGVIEW
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State | WA
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Zip | 98632-8486
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Country | US
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Telephone | 360-353-9431
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Fax | 360-353-9440
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61373120
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License Number State | WA
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