Provider Demographics
NPI:1609278399
Name:CHOW, SIMON CHI CHING (LAC)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:CHI CHING
Last Name:CHOW
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10132 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5600
Mailing Address - Country:US
Mailing Address - Phone:408-533-2446
Mailing Address - Fax:408-865-0301
Practice Address - Street 1:10132 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5600
Practice Address - Country:US
Practice Address - Phone:408-533-2446
Practice Address - Fax:408-865-0301
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14599171100000X
CARPH41414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171100000XOther Service ProvidersAcupuncturist