MEDICARE: DR. LESLIE C. CHOW D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39618	CA

General Provider Information

NPI Number	:	1124021118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE C. CHOW D.M.D.

Provider Business Mailing Address
First Line	:	1250 HERCULES AVE
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-3762
Country	:	US
Telephone Number	:	510-727-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 PINOLE VALLEY RD STE A
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-1453
Country	:	US
Telephone Number	:	510-758-6684
Fax Number	:	510-669-2083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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