Healthcare Provider Details

I. General information

NPI: 1760471049
Provider Name (Legal Business Name): KYURAN ANN CHOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST DEPT. OF RADIOLOGY
CINCINNATI OH
45267-1000
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-4391
  • Fax: 513-584-0431
Mailing address:
  • Phone: 513-245-3107
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.066639
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: