Healthcare Provider Details

I. General information

NPI: 1871775403
Provider Name (Legal Business Name): CHUN-HAN CHOU DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MIRA MAR AVE APT 1027
MEDFORD OR
97504-8556
US

IV. Provider business mailing address

1200 MIRA MAR AVE APT 1027
MEDFORD OR
97504-8556
US

V. Phone/Fax

Practice location:
  • Phone: 541-227-3764
  • Fax:
Mailing address:
  • Phone: 541-227-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD8707
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: