Provider Demographics
NPI:1225149859
Name:CHOI, JIHO (MD)
Entity Type:Individual
Prefix:
First Name:JIHO
Middle Name:
Last Name:CHOI
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 1:4216 EVERGREEN LN STE 121
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3256
Mailing Address - Country:US
Mailing Address - Phone:301-893-4124
Mailing Address - Fax:703-662-6165
Practice Address - Street 1:4216 EVERGREEN LN STE 121
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:301-893-4124
Practice Address - Fax:703-662-6165
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92152207QG0300X
DCMD040643207QG0300X
NC2006-01320207QG0300X
MDD0081318207QG0300X
VA0101252858207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225149859Medicaid
DC313884YXZXMedicare PIN
MD488572ZULCMedicare PIN