Healthcare Provider Details

I. General information

NPI: 1619098571
Provider Name (Legal Business Name): KENNETH LEE CHOI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W 86TH AVE NANI, LTD
MERRILLVILLE IN
46410-7086
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 219-791-1555
  • Fax: 219-791-1560
Mailing address:
  • Phone: 630-573-5000
  • Fax: 604-491-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036111704
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01063644A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: