Individual
KENNETH LEE CHOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 W 86TH AVE, NANI, LTD, MERRILLVILLE, IN 46410-7086
(219) 791-1555
(219) 791-1560
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000
(604) 491-5472
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01063644A
IN
207RN0300X
Nephrology Physician
036111704
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000536207
ANTHEM BCBS
IN
01
—
100082060
MEDICAID GROUP
IN
05
—
200876580
—
IN
01
—
628850
MEDICARE GROUP
IN
Enumeration date
04/02/2007
Last updated
04/29/2025
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