Healthcare Provider Details

I. General information

NPI: 1104011998
Provider Name (Legal Business Name): CHUANCHAU JERRY JOU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E MAIN ST STE 200
LEHI UT
84043-2251
US

IV. Provider business mailing address

680 E MAIN ST STE 200
LEHI UT
84043-2251
US

V. Phone/Fax

Practice location:
  • Phone: 385-477-6800
  • Fax: 855-840-2220
Mailing address:
  • Phone: 385-477-6800
  • Fax: 855-840-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number6138575-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: