Provider Demographics
NPI:1275669004
Name:CHOU, CHRISTINA LEE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEE
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-8732
Mailing Address - Country:US
Mailing Address - Phone:212-694-2000
Mailing Address - Fax:212-281-4296
Practice Address - Street 1:3332 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-8732
Practice Address - Country:US
Practice Address - Phone:212-694-2000
Practice Address - Fax:212-281-4296
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248008208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1275669004Medicaid