Healthcare Provider Details

I. General information

NPI: 1104803048
Provider Name (Legal Business Name): THEODORE CHOW MD, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SOUTH DR SUITE # 23
MOUNTAIN VIEW CA
94040-4204
US

IV. Provider business mailing address

312 LESTER CT
SANTA CLARA CA
95051-6510
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-7021
  • Fax: 650-969-8679
Mailing address:
  • Phone: 408-240-5960
  • Fax: 650-969-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC53436
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC53436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: