MEDICARE: DR. CHAD MICHAEL LOUIE D.M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1306591979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD MICHAEL LOUIE D.M.D.

Provider Business Mailing Address
First Line	:	4246 PINEHURST CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1884
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4246 PINEHURST CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1884
Country	:	US
Telephone Number	:	209-598-4074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2022
Last Update Date	:	02/12/2022

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