Provider Demographics
NPI:1225116627
Name:CHIA Y. CHOU, MD INC.
Entity Type:Organization
Organization Name:CHIA Y. CHOU, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-782-1264
Mailing Address - Street 1:1212 COLOMA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4646
Mailing Address - Country:US
Mailing Address - Phone:916-782-1264
Mailing Address - Fax:916-782-1312
Practice Address - Street 1:1212 COLOMA WAY STE A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4646
Practice Address - Country:US
Practice Address - Phone:916-782-1264
Practice Address - Fax:916-782-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30969261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA309690Medicaid
00A309690Medicare ID - Type Unspecified
CAOOA309690Medicaid