Provider Demographics
NPI:1346496494
Name:CHO, ANTHONY JAEYUN (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAEYUN
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30492 GATEWAY PL STE 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1862
Mailing Address - Country:US
Mailing Address - Phone:657-241-8601
Mailing Address - Fax:714-665-4695
Practice Address - Street 1:30492 GATEWAY PL STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1862
Practice Address - Country:US
Practice Address - Phone:657-241-8601
Practice Address - Fax:714-665-4695
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048969207Q00000X
CAC148938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine