Provider Demographics
NPI:1578534301
Name:CHON, JAE HYUNG (MD)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:HYUNG
Last Name:CHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5762 RAVENSPUR DR
Mailing Address - Street 2:#510
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3570
Mailing Address - Country:US
Mailing Address - Phone:310-665-5273
Mailing Address - Fax:
Practice Address - Street 1:6801 PARK TER
Practice Address - Street 2:100,400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1543
Practice Address - Country:US
Practice Address - Phone:310-665-5273
Practice Address - Fax:310-665-7291
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077776207XS0117X
CAG77776207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98689Medicare UPIN