MEDICARE: DR. IVAN KUO-CHUNG CHOW DDS

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	49497	CA

General Provider Information

NPI Number	:	1740494905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN KUO-CHUNG CHOW DDS

Provider Business Mailing Address
First Line	:	5610 ROSEMEAD BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5610 ROSEMEAD BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1849
Country	:	US
Telephone Number	:	626-309-1672
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/11/2007

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