Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC010626 | PA |
Y | 213ER0200X | Radiology | DC010626 | PA |
NPI | 1679695399 |
---|---|
Provider Name | Chin-Suk John Cho |
First Address | Havertown, PA 19083-4500 |
Second Address | Havertown, PA 19083-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 19/12/2012 |