Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 129 | CA |
NPI | 1013304294 |
---|---|
Provider Name | Dr. Christopher Chhoum Chow |
First Address | Santa Rosa, CA 95405-7502 |
Second Address | Santa Rosa, CA 95405-7502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 19/10/2021 |