=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639526072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON CHOW M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2016
-----------------------------------------------------
Last Update Date | 09/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9041 MAGNOLIA AVE STE 207
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-788-0222
-----------------------------------------------------
Fax | 951-299-8090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9041 MAGNOLIA AVE STE 207
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-788-0222
-----------------------------------------------------
Fax | 951-299-8090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | LP03643
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | A168267
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------