Provider Demographics
NPI:1700225521
Name:CHOU, MINT JER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINT JER
Middle Name:
Last Name:CHOU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 GRAVES AVE
Mailing Address - Street 2:BLDG. #3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5013
Mailing Address - Country:US
Mailing Address - Phone:408-366-2828
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE
Practice Address - Street 2:BLDG. #3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5013
Practice Address - Country:US
Practice Address - Phone:408-366-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist