MEDICARE: JAE HYUNG CHON 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	G077776	CA
2	207X00000X	Orthopaedic Surgery Physician	G77776	CA

General Provider Information

NPI Number	:	1578534301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE HYUNG CHON M.D.

Provider Business Mailing Address
First Line	:	5762 RAVENSPUR DR
Second Line	:	#510
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-3570
Country	:	US
Telephone Number	:	310-665-5273
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 PARK TER
Second Line	:	100,400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1543
Country	:	US
Telephone Number	:	310-665-5273
Fax Number	:	310-665-7291

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/18/2021

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