Healthcare Provider Details

I. General information

NPI: 1225149859
Provider Name (Legal Business Name): JIHO CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 EVERGREEN LN STE 121
ANNANDALE VA
22003
US

IV. Provider business mailing address

4216 EVERGREEN LN STE 121
ANNANDALE VA
22003-3256
US

V. Phone/Fax

Practice location:
  • Phone: 301-893-4124
  • Fax: 703-662-6165
Mailing address:
  • Phone: 301-893-4124
  • Fax: 703-662-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA92152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD040643
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2006-01320
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberD0081318
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0101252858
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: