Provider Demographics
NPI:1316305501
Name:KCBS VENTURES, LLC
Entity type:Organization
Organization Name:KCBS VENTURES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYUNGHO
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAEM
Authorized Official - Phone:432-695-6932
Mailing Address - Street 1:PO BOX 4143
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4143
Mailing Address - Country:US
Mailing Address - Phone:432-695-6932
Mailing Address - Fax:432-695-6934
Practice Address - Street 1:4438 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3634
Practice Address - Country:US
Practice Address - Phone:432-695-6932
Practice Address - Fax:432-695-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty