Healthcare Provider Details

I. General information

NPI: 1235759499
Provider Name (Legal Business Name): KEVIN CHOE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N LOOP RD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

390 N LOOP RD
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5247
  • Fax: 760-383-5128
Mailing address:
  • Phone: 760-383-5252
  • Fax: 760-383-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A24297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: