Provider Demographics
NPI:1487253621
Name:KIM CHO, ELLEN (DRPH, MPH, RDN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KIM CHO
Suffix:
Gender:F
Credentials:DRPH, MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ROSEWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2686
Mailing Address - Country:US
Mailing Address - Phone:909-747-7093
Mailing Address - Fax:
Practice Address - Street 1:530 ROSEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2686
Practice Address - Country:US
Practice Address - Phone:909-747-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86019120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86019120OtherCDR