Provider Demographics
NPI:1134486681
Name:CHOI, KEVIN JAE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAE
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:966 S WESTERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1014
Mailing Address - Country:US
Mailing Address - Phone:213-267-2566
Mailing Address - Fax:213-463-9131
Practice Address - Street 1:966 S WESTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1014
Practice Address - Country:US
Practice Address - Phone:213-267-2566
Practice Address - Fax:213-463-9131
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2020-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA156572207YX0602X, 207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology