Provider Demographics
NPI:1891023784
Name:TAK K CHOW M D INCORPORATED
Entity Type:Organization
Organization Name:TAK K CHOW M D INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAK
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-252-2168
Mailing Address - Street 1:PO BOX 1926
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92312-1926
Mailing Address - Country:US
Mailing Address - Phone:760-252-2168
Mailing Address - Fax:818-957-2194
Practice Address - Street 1:500 S 7TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3056
Practice Address - Country:US
Practice Address - Phone:760-252-2168
Practice Address - Fax:818-957-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A296040Medicaid
CA00A296040Medicaid