Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 0101235723 | VA |
NPI | 1629109061 |
---|---|
Provider Name | Kyle Seung Choe |
First Address | Virginia Beach, VA 23462-3109 |
Second Address | Virginia Beach, VA 23462-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H85423 | (02) |