MEDICARE: JAE HYUNG 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	207R00000X	Internal Medicine Physician	A125758	CA
2	208M00000X	Hospitalist Physician	A125758	CA
3	207RC0000X	Cardiovascular Disease Physician	A125758	CA

General Provider Information

NPI Number	:	1407165434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE HYUNG CHO M.D.

Provider Business Mailing Address
First Line	:	2727 W OLYMPIC BLVD STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2640
Country	:	US
Telephone Number	:	213-908-6434
Fax Number	:	213-908-5986

Provider Business Practice Location Address
First Line	:	2727 W OLYMPIC BLVD STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2640
Country	:	US
Telephone Number	:	213-908-6434
Fax Number	:	213-908-5986

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

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	08/21/2023

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