Provider Demographics
NPI:1689660672
Name:CHOI, JAE HO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:HO
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-741-4470
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:6567 E CARONDELET DR STE 441
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2156
Practice Address - Country:US
Practice Address - Phone:520-751-0360
Practice Address - Fax:520-751-2521
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2016-01-25
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Provider Licenses
StateLicense IDTaxonomies
AZ29854207R00000X
NV14812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ625048Medicaid
AZAZ0759630OtherBCBS OF AZ
AZP00101946OtherRAILROAD MEDICARE
AZAZ0759630OtherBCBS OF AZ
AZP00101946OtherRAILROAD MEDICARE