MEDICARE: DR. SUNG J CHO PSY.D.

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	103TC0700X	Clinical Psychologist	071007249	IL
2	103TC0700X	Clinical Psychologist	PY0975	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071007249	OTHER	IL	LICENSE NUMBER
2	406120002	OTHER		PTAN
3	PY0975	OTHER	NV	LICENSE NUMBER

General Provider Information

NPI Number	:	1770789307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNG J CHO PSY.D.

Provider Business Mailing Address
First Line	:	11035 LAVENDER HILL DR STE 160-605
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2955
Country	:	US
Telephone Number	:	312-371-7321
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 W GOWAN RD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6603
Country	:	US
Telephone Number	:	312-371-7321
Fax Number	:

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	04/30/2025

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