MEDICARE: YEILIM CHO M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program		MN
2	207Q00000X	Family Medicine Physician	61035183	WA
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	0101259547	VA

General Provider Information

NPI Number	:	1366670861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEILIM CHO M.D.

Provider Business Mailing Address
First Line	:	5608 17TH AVE NW # 888
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5232
Country	:	US
Telephone Number	:	651-497-9410
Fax Number	:

Provider Business Practice Location Address
First Line	:	5608 17TH AVE NW # 888
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5232
Country	:	US
Telephone Number	:	651-497-9410
Fax Number	:

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	05/22/2020

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