Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | E4187 | CA |
N | 2081S0010X | Sports Medicine | E4187 | CA |
N | 213ES0000X | Sports Medicine | E4187 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4187 | CA |
NPI | 1598708547 |
---|---|
Provider Name | Dr. Mike C Jou |
First Address | La Habra, CA 90631-4060 |
Second Address | La Habra, CA 90631-4060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E41870 | (05) | CA |
5720332 | (05) | CA |
U76768 | (02) | CA |
W20188 | MEDICARE GROUP ID (01) | CA |