Healthcare Provider Details

I. General information

NPI: 1720622947
Provider Name (Legal Business Name): JAEMOON CHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 159TH ST STE 2
FLUSHING NY
11358-1667
US

IV. Provider business mailing address

16608 24TH RD APT 2F
WHITESTONE NY
11357-4046
US

V. Phone/Fax

Practice location:
  • Phone: 718-661-1500
  • Fax:
Mailing address:
  • Phone: 917-558-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number007672
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007420
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: