Provider Demographics
NPI:1316919046
Name:CHOE, IAN (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-383-6210
Mailing Address - Fax:702-435-7050
Practice Address - Street 1:2845 SIENA HEIGHTS DR
Practice Address - Street 2:URGENT CARE
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4153
Practice Address - Country:US
Practice Address - Phone:702-617-1227
Practice Address - Fax:702-616-2069
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12286207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFL601ZOtherSMACC MEDICARE
NVV105550OtherMEDICARE REVALIDATION
NVV105550OtherMEDICARE REVALIDATION
I27811Medicare UPIN
ORR131156Medicare PIN