Healthcare Provider Details

I. General information

NPI: 1972986230
Provider Name (Legal Business Name): MARK YUN CHOE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PEELER ST
KALAMAZOO MI
49008-2300
US

IV. Provider business mailing address

7380 ANNANDALE DR
KALAMAZOO MI
49009-4133
US

V. Phone/Fax

Practice location:
  • Phone: 269-345-8618
  • Fax: 269-345-1508
Mailing address:
  • Phone: 517-420-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704267761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: