Provider Demographics
NPI:1275630824
Name:YOON J CHO DO LLC
Entity Type:Organization
Organization Name:YOON J CHO DO LLC
Other - Org Name:GENESIS FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-871-3400
Mailing Address - Street 1:6161 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3901
Mailing Address - Country:US
Mailing Address - Phone:301-871-3400
Mailing Address - Fax:301-871-3441
Practice Address - Street 1:6161 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-871-3400
Practice Address - Fax:301-871-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0060318261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI14506Medicare UPIN