Healthcare Provider Details

I. General information

NPI: 1871721563
Provider Name (Legal Business Name): CHAE M. KO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 RECOVERY RD STE 201
NASHVILLE TN
37211-4874
US

IV. Provider business mailing address

510 RECOVERY RD STE 201
NASHVILLE TN
37211-4874
US

V. Phone/Fax

Practice location:
  • Phone: 615-781-4433
  • Fax: 615-781-4432
Mailing address:
  • Phone: 615-781-4433
  • Fax: 615-781-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number50011
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50011
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: