Provider Demographics
NPI:1598708547
Name:JOU, MIKE C (DPM)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:C
Last Name:JOU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4060
Mailing Address - Country:US
Mailing Address - Phone:626-820-0924
Mailing Address - Fax:626-820-0925
Practice Address - Street 1:501 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-4060
Practice Address - Country:US
Practice Address - Phone:626-820-0924
Practice Address - Fax:626-820-0925
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4187213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5720332Medicaid
CAW20188OtherMEDICARE GROUP ID
CA000E41870Medicaid
CAW20188OtherMEDICARE GROUP ID
CAWE4187DMedicare PIN
CAU76768Medicare UPIN
CAE4187Medicare ID - Type Unspecified