Provider Demographics
NPI:1336150077
Name:CHOW, TAK KEUNG (MD)
Entity Type:Individual
Prefix:
First Name:TAK
Middle Name:KEUNG
Last Name:CHOW
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: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:760-252-2168
Practice Address - Street 1:500 S. 7TH AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3044
Practice Address - Country:US
Practice Address - Phone:760-252-2168
Practice Address - Fax:760-252-2168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A25825Medicare UPIN
CAA25825Medicare UPIN
CA00A296040Medicare ID - Type UnspecifiedPROVIDER NUMBER
CA00A296040Medicare PIN