MEDICARE: DR. JAE HO CHOI 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	29854	AZ
2	207R00000X	Internal Medicine Physician	14812	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00101946	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AZ0759630	OTHER	AZ	BCBS OF AZ

General Provider Information

NPI Number	:	1689660672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAE HO CHOI M.D.

Provider Business Mailing Address
First Line	:	12900 PARK PLAZA DR
Second Line	:	STE 150
City	:	CERRITOS
State	:	CA
Zip	:	90703-9329
Country	:	US
Telephone Number	:	562-741-4470
Fax Number	:	562-741-4479

Provider Business Practice Location Address
First Line	:	6567 E CARONDELET DR STE 441
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2156
Country	:	US
Telephone Number	:	520-751-0360
Fax Number	:	520-751-2521

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	01/25/2016

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Directions to “ DR. JAE HO CHOI M.D.” Practice Location

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