MEDICARE: HUBERT WING CHOW 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	207Q00000X	Family Medicine Physician	G45435	CA

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	:	1669697686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUBERT WING CHOW M.D.

Provider Business Mailing Address
First Line	:	5360 MOUNTAIN SPRINGS RANCH RD
Second Line	:
City	:	LA VERNE
State	:	CA
Zip	:	91750-1028
Country	:	US
Telephone Number	:	909-596-3453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 E LAS TUNAS DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1701
Country	:	US
Telephone Number	:	626-286-8473
Fax Number	:	626-286-9177

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	01/10/2018

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