Provider Demographics
NPI:1053309369
Name:CHOU, GRACE S (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:S
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2160 APPIAN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2524
Mailing Address - Country:US
Mailing Address - Phone:510-724-9110
Mailing Address - Fax:916-239-3602
Practice Address - Street 1:2160 APPIAN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2524
Practice Address - Country:US
Practice Address - Phone:510-724-9110
Practice Address - Fax:916-239-3611
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A634031Medicare PIN
CAG86866Medicare UPIN
CA00A634030Medicare PIN