Provider Demographics
NPI:1184915373
Name:CHOI, KELLEN BO YUNG (DO)
Entity type:Individual
Prefix:DR
First Name:KELLEN
Middle Name:BO YUNG
Last Name:CHOI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0330
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST UNIT 480
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5704
Practice Address - Country:US
Practice Address - Phone:502-588-4740
Practice Address - Fax:502-588-9537
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60181208800000X
KYTP281208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK246190OtherMEDICARE
IN300010321Medicaid
KY7100569410Medicaid