Provider Demographics
NPI:1316986938
Name:CHOI, KYU (MD)
Entity type:Individual
Prefix:
First Name:KYU
Middle Name:
Last Name:CHOI
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 1:20 EXECUTIVE PARK
Mailing Address - Street 2:STE 155
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6736
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-503-7224
Practice Address - Street 1:147 N BRENT ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2809
Practice Address - Country:US
Practice Address - Phone:805-652-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC511762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C511760Medicaid
CA00C511760OtherBLUE SHIELD OF CA
CAP00066853Medicare PIN
CAWC51176AMedicare PIN
CA00C511760OtherBLUE SHIELD OF CA
CA00C511760Medicaid