Provider Demographics
NPI:1699912378
Name:CHOE CENTER FOR FACIAL PLASTIC SURGERY
Entity type:Organization
Organization Name:CHOE CENTER FOR FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-389-5850
Mailing Address - Street 1:4400 CORPORATION LANE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-389-5850
Mailing Address - Fax:757-499-3745
Practice Address - Street 1:4400 CORPORATION LANE
Practice Address - Street 2:SUITE #102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-389-5850
Practice Address - Fax:757-499-3745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOE CENTER FOR FACIAL PLASTIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235723207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty