Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A99950 | CA |
NPI | 1003036187 |
---|---|
Provider Name | Miriam Cho |
First Address | Riverside, CA 92506-3912 |
Second Address | Riverside, CA 92506-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A99950 | LICENSE (01) | CA |
ZZZ31887Z | SITE PTAN (01) | CA |