Healthcare Provider Details

I. General information

NPI: 1518163302
Provider Name (Legal Business Name): DAVID CHOW D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 FRANKLIN AVE
NUTLEY NJ
07110-3823
US

IV. Provider business mailing address

1680 WESTWOOD DR STE D
SAN JOSE CA
95125-5105
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-1020
  • Fax:
Mailing address:
  • Phone: 408-266-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52808
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: