MEDICARE: JAISOHN HOME CARE, INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1750409496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAISOHN HOME CARE, INC.

Provider Business Mailing Address
First Line	:	6705 OLD YORK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2841
Country	:	US
Telephone Number	:	215-224-2137
Fax Number	:	215-224-9164

Provider Business Practice Location Address
First Line	:	6705 OLD YORK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2841
Country	:	US
Telephone Number	:	215-224-2137
Fax Number	:	215-224-9164

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WHAN SOON CHUNG
Credential	:	M.D.
Telephone Number	:	215-224-2040

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/22/2009

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