Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12380 | CT |
Y | 213EG0000X | General Practice | 12380 | CT |
NPI | 1003384975 |
---|---|
Provider Name | Sung Woo Cho |
First Address | New London, CT 06320-2641 |
Second Address | New London, CT 06320-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2018 |
Last Update Date | 08/11/2018 |