MEDICARE: JAEHUN CHO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DDS105325	CA

General Provider Information

NPI Number	:	1245845825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAEHUN CHO

Provider Business Mailing Address
First Line	:	2801 SUNSET PL APT 2202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-4535
Country	:	US
Telephone Number	:	628-224-1560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-3768
Country	:	US
Telephone Number	:	626-584-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	03/11/2026

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