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General NPI Number Information
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NPI Number | 1245459619
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Entity Type | Individual
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Provider Name | SUSAN HYUN KYUNG CHO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 17053 FOOTHILL BLVD BLDG B
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City | FONTANA
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State | CA
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Zip | 92335-3574
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Country | US
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Telephone | 951-836-3975
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E VANDERBILT WAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0026
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Country | US
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Telephone | 909-252-5149
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Fax |
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A87593
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License Number State | CA
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