MEDICARE: DR. HUNG KANG OU MD

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	A41511	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	:	1942219944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUNG KANG OU MD

Provider Business Mailing Address
First Line	:	4195 CHINO HILLS PKWY STE H
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2618
Country	:	US
Telephone Number	:	909-597-7817
Fax Number	:	909-597-7984

Provider Business Practice Location Address
First Line	:	4195 CHINO HILLS PKWY STE H
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2618
Country	:	US
Telephone Number	:	909-597-7817
Fax Number	:	909-597-7984

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/27/2018

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