MEDICARE: DR. KEVIN JAE CHOI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0602X	Otolaryngic Allergy Physician	A156572	CA
2	207YP0228X	Pediatric Otolaryngology Physician	A156572	CA
3	207Y00000X	Otolaryngology Physician	A156572	CA

General Provider Information

NPI Number	:	1134486681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JAE CHOI M.D.

Provider Business Mailing Address
First Line	:	966 S WESTERN AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1014
Country	:	US
Telephone Number	:	213-267-2566
Fax Number	:	213-463-9131

Provider Business Practice Location Address
First Line	:	966 S WESTERN AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1014
Country	:	US
Telephone Number	:	213-267-2566
Fax Number	:	213-463-9131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	07/29/2020

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