=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811618093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATY CHOU DDS DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2022
-----------------------------------------------------
Last Update Date | 09/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13175 PARAMOUNT BLVD
-----------------------------------------------------
City | SOUTH GATE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90280-7955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-633-9185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13175 PARAMOUNT BLVD
-----------------------------------------------------
City | SOUTH GATE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90280-7955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATY CHOU
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 626-688-3829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------