MEDICARE: MR. EDMOND KENNETH 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	1223E0200X	Endodontics	035694	CA
2	1223E0200X	Endodontics	S7-117C	NV

General Provider Information

NPI Number	:	1891933875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDMOND KENNETH CHOW DDS

Provider Business Mailing Address
First Line	:	10818 ROSIN JAW STREET
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4507
Country	:	US
Telephone Number	:	916-804-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	10818 ROSIN JAW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4507
Country	:	US
Telephone Number	:	916-804-8989
Fax Number	:

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

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	08/25/2021

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