Provider Demographics
NPI:1407937147
Name:CHOU, SUSANA MIN SHYAN (DDS)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:MIN SHYAN
Last Name:CHOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1562
Mailing Address - Country:US
Mailing Address - Phone:415-507-9728
Mailing Address - Fax:
Practice Address - Street 1:1615 HILL RD STE 2
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4304
Practice Address - Country:US
Practice Address - Phone:415-898-0091
Practice Address - Fax:415-898-9066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice