Healthcare Provider Details

I. General information

NPI: 1134486681
Provider Name (Legal Business Name): KEVIN JAE CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 S WESTERN AVE STE 101
LOS ANGELES CA
90006-1014
US

IV. Provider business mailing address

966 S WESTERN AVE STE 101
LOS ANGELES CA
90006-1014
US

V. Phone/Fax

Practice location:
  • Phone: 213-267-2566
  • Fax: 213-463-9131
Mailing address:
  • Phone: 213-267-2566
  • Fax: 213-463-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA156572
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA156572
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberA156572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: