Basic Information
| Provider Information | |||||||||
| NPI: | 1184915001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17360 BROOKHURST ST | ||||||||
| Address2: | C/O MCMF- CREDENTIALING DEPARTMENT | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927083720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6572413616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17360 BROOKHURST ST | ||||||||
| Address2: | C/O - MCMF - CREDENTIALING DEPARTMENT | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927083720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146651797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 09/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A124103 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1598084386 | 01 | CA | MEDI-CAL | OTHER |