1316919046 NPI number — IAN CHOE M.D.

Table of content: IAN CHOE M.D. (NPI 1316919046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316919046 NPI number — IAN CHOE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOE
Provider First Name:
IAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316919046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89114-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-562-4675
Provider Business Mailing Address Fax Number:
702-838-1456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 SIENA HEIGHTS DR
Provider Second Line Business Practice Location Address:
URGENT CARE
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-4153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-617-1227
Provider Business Practice Location Address Fax Number:
702-616-2069
Provider Enumeration Date:
02/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  12286 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FL601Z . This is a "SMACC MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: V105550 . This is a "MEDICARE REVALIDATION" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".