Provider Demographics
NPI:1013020338
Name:CHO, JAI (MD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2862
Mailing Address - Country:US
Mailing Address - Phone:813-977-4001
Mailing Address - Fax:813-971-3688
Practice Address - Street 1:14451 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2862
Practice Address - Country:US
Practice Address - Phone:813-977-4001
Practice Address - Fax:813-971-3688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL409111397OtherRAILROAD MEDICARE
FL30193OtherBCBS
FL30192Medicare ID - Type UnspecifiedMEDICARE
FLK3046Medicare ID - Type UnspecifiedGROUP MEDICARE
FL30193ZMedicare PIN
FL30193OtherBCBS