Healthcare Provider Details

I. General information

NPI: 1710112677
Provider Name (Legal Business Name): JAMES CHOU DDS DENTAL GROUP OF FULLERTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 BREA BLVD
FULLERTON CA
92835-2073
US

IV. Provider business mailing address

2949 BREA BLVD
FULLERTON CA
92835-2073
US

V. Phone/Fax

Practice location:
  • Phone: 714-671-0300
  • Fax: 714-671-0399
Mailing address:
  • Phone: 714-671-0300
  • Fax: 714-671-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES CHOU
Title or Position: OWNER/DENTIST
Credential: DDS.,MS
Phone: 714-671-0300