Provider Demographics
NPI:1407194293
Name:CHOI, JAY KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:KENNETH
Last Name:CHOI
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 1:1728 W. BLUEWATER HWY.
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846
Mailing Address - Country:US
Mailing Address - Phone:616-527-3100
Mailing Address - Fax:
Practice Address - Street 1:1728 W BLUEWATER HWY
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8553
Practice Address - Country:US
Practice Address - Phone:616-527-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010333472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry