Provider Demographics
NPI:1689627838
Name:CHOU, ERIC T (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:T
Last Name:CHOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2005
Practice Address - Country:US
Practice Address - Phone:619-295-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2162692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A960950Medicaid
CAWA96095JMedicare PIN
CAWA96095AMedicare PIN
CAWA96095BMedicare PIN
CAWA96095EMedicare PIN
CA00A960950Medicare PIN
CA00A960950Medicaid
CAWA96095HMedicare PIN
CAWA96095CMedicare PIN
CAP00326314Medicare PIN
I30396Medicare UPIN
CAWA96095FMedicare PIN
CAWA96095GMedicare PIN
CAWA96095Medicare PIN
CAWA96095IMedicare PIN