Healthcare Provider Details

I. General information

NPI: 1427133040
Provider Name (Legal Business Name): MIKE C JOU DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N HARBOR BLVD
LA HABRA CA
90631-4060
US

IV. Provider business mailing address

501 N HARBOR BLVD
LA HABRA CA
90631-4060
US

V. Phone/Fax

Practice location:
  • Phone: 626-820-0924
  • Fax: 626-820-0925
Mailing address:
  • Phone: 626-820-0924
  • Fax: 626-820-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberE4187
License Number StateCA

VIII. Authorized Official

Name: DR. MIKE C JOU
Title or Position: CEO
Credential: D.P.M.
Phone: 626-820-0924