Provider Demographics
NPI:1104011998
Name:JOU, CHUANCHAU JERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHUANCHAU
Middle Name:JERRY
Last Name:JOU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W STE 401
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3306
Mailing Address - Country:US
Mailing Address - Phone:385-477-6800
Mailing Address - Fax:385-477-6801
Practice Address - Street 1:1055 N 300 W STE 311
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3373
Practice Address - Country:US
Practice Address - Phone:385-477-6800
Practice Address - Fax:385-477-6801
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6138575-12042080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology