Provider Demographics
NPI:1982759395
Name:CHOU WU, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CHOU WU, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOU
Authorized Official - Middle Name:YING
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-522-4173
Mailing Address - Street 1:5716 ANCHOR BAY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6840
Mailing Address - Country:US
Mailing Address - Phone:915-533-4173
Mailing Address - Fax:
Practice Address - Street 1:5716 ANCHOR BAY WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6840
Practice Address - Country:US
Practice Address - Phone:916-533-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG065603261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G656030Medicaid
CA00G656032Medicare ID - Type Unspecified
CA00G656030Medicaid