Provider Demographics
NPI:1316979784
Name:CHO, JAI JONG (MD)
Entity type:Individual
Prefix:DR
First Name:JAI
Middle Name:JONG
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3046 BERKMAR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1444
Mailing Address - Country:US
Mailing Address - Phone:434-973-3356
Mailing Address - Fax:434-973-2363
Practice Address - Street 1:3046 BERKMAR DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1444
Practice Address - Country:US
Practice Address - Phone:434-973-3356
Practice Address - Fax:434-973-2363
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034437207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080000239OtherMEDICARE PTAN
VA5628547Medicaid
VA361921OtherANTHEM BC-BS-MEDICARE EXTENDED SUPPLEMENT
B08202Medicare UPIN