MEDICARE: DR. LI CHOU D.D.S.

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	1223G0001X	General Practice Dentistry	012024	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356434641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LI CHOU D.D.S.

Provider Business Mailing Address
First Line	:	3206 SHALLOWFORD RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-3633
Country	:	US
Telephone Number	:	770-457-6603
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 SHALLOWFORD RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-3633
Country	:	US
Telephone Number	:	770-457-6603
Fax Number	:

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LI CHOU D.D.S.” Practice Location

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