Healthcare Provider Details

I. General information

NPI: 1215984513
Provider Name (Legal Business Name): JOHN C CHOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S SAN MATEO DRIVE SUITE 100
SAN MATEO CA
94401
US

IV. Provider business mailing address

101 S SAN MATEO DRIVE SUITE 100
SAN MATEO CA
94401
US

V. Phone/Fax

Practice location:
  • Phone: 650-347-0063
  • Fax:
Mailing address:
  • Phone: 650-347-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG75391
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG75391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: