Provider Demographics
NPI:1831731611
Name:KEVIN JAE CHOI, MD, MS A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:KEVIN JAE CHOI, MD, MS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-267-2256
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:213-267-2256
Practice Address - Fax:213-463-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-12
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty