Provider Demographics
NPI:1457532053
Name:IVAN K CHOW DDS INC
Entity Type:Organization
Organization Name:IVAN K CHOW DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:KUO-CHUNG
Authorized Official - Last Name:CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-309-1672
Mailing Address - Street 1:5610 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1849
Mailing Address - Country:US
Mailing Address - Phone:626-309-1672
Mailing Address - Fax:
Practice Address - Street 1:5610 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1849
Practice Address - Country:US
Practice Address - Phone:626-309-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty