Provider Demographics
NPI:1629109061
Name:CHOE, KYLE SEUNG (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:SEUNG
Last Name:CHOE
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 1:4400 CORPORATION LN
Mailing Address - Street 2:SUITE #102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3109
Mailing Address - Country:US
Mailing Address - Phone:757-389-5850
Mailing Address - Fax:757-499-3745
Practice Address - Street 1:4400 CORPORATION LN
Practice Address - Street 2:SUITE #102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3109
Practice Address - Country:US
Practice Address - Phone:757-389-5850
Practice Address - Fax:757-499-3745
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235723207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85423Medicare UPIN