=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881793362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERIDOCS MEDICAL GROUP,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2621 S BRISTOL ST STE 203
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-662-2256
-----------------------------------------------------
Fax | 714-662-0178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 S BRISTOL ST STE 203
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-662-2256
-----------------------------------------------------
Fax | 714-662-0178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALLEN CHINPIN CHOU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-662-2256
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | A36505
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------