Provider Demographics
NPI:1508942780
Name:CHOU, TINA R (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4955 VAN NUYS BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1817
Mailing Address - Country:US
Mailing Address - Phone:818-325-0200
Mailing Address - Fax:818-325-0210
Practice Address - Street 1:4955 VAN NUYS BLVD STE 502
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1817
Practice Address - Country:US
Practice Address - Phone:818-325-0200
Practice Address - Fax:818-325-0210
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90540207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI9699136Medicaid
HI9699136Medicaid