Provider Demographics
NPI:1689872368
Name:CHI, JOHN JEONHWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEONHWAN
Last Name:CHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-3880
Mailing Address - Fax:314-996-8610
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DEPT OTOLARYNGOLOGY, STE L10
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-996-3880
Practice Address - Fax:314-996-8610
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013009580207YX0007X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200006351Medicaid
MO1689872368Medicaid