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NPI Code Detail

MEDICARE: KEVIN JAE CHOI, MD, MS A PROFESSIONAL MEDICAL CORPORATION

MEDICARE: KEVIN JAE CHOI, MD, MS A PROFESSIONAL MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician
2261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1831731611
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEVIN JAE CHOI, MD, MS A PROFESSIONAL MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 966 S WESTERN AVE STE 101
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-1014
Country : US
Telephone Number : 213-267-2566
Fax Number : 213-463-9131
Provider Business Practice Location Address
First Line : 966 S WESTERN AVE STE 101
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-1014
Country : US
Telephone Number : 213-267-2256
Fax Number : 213-463-9131
Authorized Official
Title or Position : PHYSICIAN
Name : DR. KEVIN JAE CHOI
Credential : MD
Telephone Number : 213-267-2256
Provider Enumeration Date : 10/12/2019
Last Update Date : 09/29/2022

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