MEDICARE: DR. SCOTT CUONG CHAU D.D.S.

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	122300000X	Dentist	55343	CA

General Provider Information

NPI Number	:	1578779104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT CUONG CHAU D.D.S.

Provider Business Mailing Address
First Line	:	2425 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1515
Country	:	US
Telephone Number	:	619-855-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1515
Country	:	US
Telephone Number	:	619-855-8156
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/16/2013

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