Provider Demographics
NPI:1649450628
Name:CHOU, STELLA YI (MD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:YI
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8789 S HIGHLAND DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1600
Mailing Address - Country:US
Mailing Address - Phone:801-943-4999
Mailing Address - Fax:801-943-3876
Practice Address - Street 1:8789 S HIGHLAND DR
Practice Address - Street 2:STE 100
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1600
Practice Address - Country:US
Practice Address - Phone:801-943-4999
Practice Address - Fax:801-943-3876
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325931-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2940OtherMEDICAID LICENSE NUMBER
UT1649450628Medicaid
UT000061996Medicare PIN
UTH01180Medicare UPIN
UTD2940OtherMEDICAID LICENSE NUMBER