Provider Demographics
NPI:1346383981
Name:CHOW, JACKY POLAM (DMD, MSC)
Entity Type:Individual
Prefix:DR
First Name:JACKY
Middle Name:POLAM
Last Name:CHOW
Suffix:
Gender:M
Credentials:DMD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUTTER ST.,
Mailing Address - Street 2:819
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1117
Mailing Address - Country:US
Mailing Address - Phone:415-391-1060
Mailing Address - Fax:
Practice Address - Street 1:500 SUTTER ST.,
Practice Address - Street 2:819
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1117
Practice Address - Country:US
Practice Address - Phone:415-391-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice