Provider Demographics
NPI:1649937574
Name:CHON, HA JAE (APN)
Entity type:Individual
Prefix:
First Name:HA JAE
Middle Name:
Last Name:CHON
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:CHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:973-926-8534
Mailing Address - Fax:973-391-8533
Practice Address - Street 1:201 LYONS AVE STE L4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-8534
Practice Address - Fax:973-391-8533
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01231000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology