Provider Demographics
NPI:1447338934
Name:CHOFLA, MARK (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CHOFLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5960 S LAND PARK DR
Mailing Address - Street 2:#326
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3313
Mailing Address - Country:US
Mailing Address - Phone:916-760-8197
Mailing Address - Fax:888-661-6285
Practice Address - Street 1:1909 CAPITOL AVE
Practice Address - Street 2:#100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-4235
Practice Address - Country:US
Practice Address - Phone:916-760-8197
Practice Address - Fax:888-661-6285
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A83652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
020A83650Medicare ID - Type Unspecified