MEDICARE: CHO MAR WIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95021280	CA

General Provider Information

NPI Number	:	1396467320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHO MAR WIN FNP

Provider Business Mailing Address
First Line	:	1729 CRAIGTON AVE
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-3609
Country	:	US
Telephone Number	:	626-278-9701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 E VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-3717
Country	:	US
Telephone Number	:	323-908-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	11/28/2023

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