Provider Demographics
NPI:1447293337
Name:CHO, DAVIS K (MD)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:K
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4419
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4419
Mailing Address - Country:US
Mailing Address - Phone:877-484-3035
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:1002 BELLEVUE ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4006
Practice Address - Country:US
Practice Address - Phone:503-814-4400
Practice Address - Fax:503-814-7264
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79200207P00000X
ORMD173891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00173115OtherRAILROAD MEDICARE
CA00G792000OtherBLUE SHIELD
OR500696161Medicaid
CA00G792000Medicaid
CA00G792002Medicare ID - Type Unspecified
CA00G792000OtherBLUE SHIELD