Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101034437 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0101034437 | VA |
NPI | 1316979784 |
---|---|
Provider Name | Dr. Jai Jong Cho |
First Address | Charlottesville, VA 22901-1444 |
Second Address | Charlottesville, VA 22901-1444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 10/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080000239 | MEDICARE PTAN (01) | VA |
361921 | ANTHEM BC-BS-MEDICARE EXTENDED SUPPLEMENT (01) | VA |
5628547 | (05) | VA |
B08202 | (02) |