Basic Information
| Provider Information | |||||||||
| NPI: | 1164423786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOI | ||||||||
| FirstName: | KELLEN | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 S MAIN ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601482670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306467000 | ||||||||
| FaxNumber: | 6305481563 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 S MAIN ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601482670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306467000 | ||||||||
| FaxNumber: | 6305481563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2005 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 036106615 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.