Provider Demographics
NPI:1275862229
Name:CHOW, KENNETH (LIC AC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CHOW
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15049 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-2602
Mailing Address - Country:US
Mailing Address - Phone:225-229-5123
Mailing Address - Fax:225-218-0159
Practice Address - Street 1:15049 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70819-2602
Practice Address - Country:US
Practice Address - Phone:225-229-5123
Practice Address - Fax:225-218-0159
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAACA. C20016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist