Provider Demographics
NPI:1972514933
Name:CHOU,, CHIA YIAN (MD,)
Entity type:Individual
Prefix:DR
First Name:CHIA
Middle Name:YIAN
Last Name:CHOU,
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 1:1212 COLOMA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4646
Mailing Address - Country:US
Mailing Address - Phone:916-782-1264
Mailing Address - Fax:916-782-1312
Practice Address - Street 1:1212 COLOMA WAY STE A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4646
Practice Address - Country:US
Practice Address - Phone:916-782-1264
Practice Address - Fax:916-782-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A309690Medicaid
CA00A309690Medicaid
A-26296Medicare UPIN