Individual provider Active NPI

Anthony Jaeyun Cho, M.D.

  • Family Medicine Physician
  • Rancho Mission Viejo, CA
National Provider Identifier
1346496494
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C148938 Issued in CA
Practice address
30492 Gateway PL Ste 110
Rancho Mission Viejo, CA 92694-1862
Phone
(657) 241-8601
Fax
(714) 665-4695
NPI assigned
Aug 8, 2008
Last updated
Dec 9, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00048969 WA
Family Medicine Physician 207Q00000X C148938 CA Primary

Addresses

Primary practice location

30492 Gateway PL Ste 110
Rancho Mission Viejo, CA 92694-1862

Mailing address

30492 Gateway PL Ste 110
Rancho Mission Viejo, CA 92694-1862
Phone (657) 241-8601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180307001264 CA Practitioner - Family Practice 5597832584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

30707 Gateway PL
Suite A2
Rancho Mission Viejo, CA 92694-1856
Phone (657) 241-8435

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C148938CAMDFamily Medicine Physician
MD00048969WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Family Medicine CurrentSince Mar 15, 2018 Accepting new patients
Bristol Park Medical Group, Inc Family Medicine PastSince Mar 15, 2018 Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

30492 Gateway Pl
Ste 110
Rancho Mission Viejo, CA 92694
Phone (657) 241-8601

1300 Avenida Vista Hermosa
Ste 250
San Clemente, CA 92673
Phone (949) 240-2030

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: acho487661@direct.memorialcare.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1346496494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30492 GATEWAY PL STE 110",
            "city": "RANCHO MISSION VIEJO",
            "state": "CA",
            "postal_code": "926941862",
            "telephone_number": "657-241-8601",
            "fax_number": "714-665-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30492 GATEWAY PL STE 110",
            "city": "RANCHO MISSION VIEJO",
            "state": "CA",
            "postal_code": "926941862",
            "telephone_number": "657-241-8601",
            "fax_number": "714-665-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHO",
        "first_name": "ANTHONY",
        "middle_name": "JAEYUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-08",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00048969",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C148938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.