Healthcare Provider Details

I. General information

NPI: 1417161472
Provider Name (Legal Business Name): CHOU YANG I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 K ST
MODESTO CA
95354-1018
US

IV. Provider business mailing address

913 LEMA AVE
MODESTO CA
95351-3873
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-4573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: