Provider Demographics
NPI:1790922896
Name:HOU, JACK CHENG-TSUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:CHENG-TSUNG
Last Name:HOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1739 E BEVERLY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-681-8686
Mailing Address - Fax:928-681-8690
Practice Address - Street 1:1739 E BEVERLY AVE STE 106
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-681-8686
Practice Address - Fax:928-681-8690
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132236208800000X
AZ51385208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology