Healthcare Provider Details

I. General information

NPI: 1447175468
Provider Name (Legal Business Name): MICHAEL CHOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD STE 1211
LOS ANGELES CA
90045-3819
US

IV. Provider business mailing address

11649 MAYFIELD AVE APT 9E
LOS ANGELES CA
90049-5779
US

V. Phone/Fax

Practice location:
  • Phone: 310-215-1180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: