Provider Demographics
NPI:1568826568
Name:CHO, YUN JAE (DO)
Entity Type:Individual
Prefix:
First Name:YUN
Middle Name:JAE
Last Name:CHO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 QUEENS PLZ S
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4101
Mailing Address - Country:US
Mailing Address - Phone:646-647-1261
Mailing Address - Fax:
Practice Address - Street 1:3830 PARSONS BLVD STE 1D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5841
Practice Address - Country:US
Practice Address - Phone:718-762-1710
Practice Address - Fax:718-762-1753
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY305092-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program