=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700082179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM CHOW DO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13851 E 14TH ST SUITE 308
-----------------------------------------------------
City | SAN LEANDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94578-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-895-0510
-----------------------------------------------------
Fax | 510-895-5887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13851 E 14TH ST SUITE 308
-----------------------------------------------------
City | SAN LEANDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94578-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-895-0510
-----------------------------------------------------
Fax | 510-895-5887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DERMATOLOGIST
-----------------------------------------------------
Name | DR. WILLIAM C CHOW
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 510-895-0510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 20A4862
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------