Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A136034 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A136034 | CA |
NPI | 1508151556 |
---|---|
Provider Name | Conroy Chow |
First Address | Loma Linda, CA 92354-3895 |
Second Address | Loma Linda, CA 92354-3895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 14/06/2021 |