MEDICARE: CHOW MEDICAL CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A7057	CA

General Provider Information

NPI Number	:	1053771394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOW MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	817 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	213-385-0029
Fax Number	:	213-385-5619

Provider Business Practice Location Address
First Line	:	817 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	213-385-0029
Fax Number	:	213-385-5619

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRUCE CHOW
Credential	:	D.O.
Telephone Number	:	213-385-0029

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	05/13/2016

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