Provider Demographics
NPI:1669697686
Name:CHOW, HUBERT WING (MD)
Entity type:Individual
Prefix:
First Name:HUBERT
Middle Name:WING
Last Name:CHOW
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 1:5360 MOUNTAIN SPRINGS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1028
Mailing Address - Country:US
Mailing Address - Phone:909-596-3453
Mailing Address - Fax:
Practice Address - Street 1:1111 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1701
Practice Address - Country:US
Practice Address - Phone:626-286-8473
Practice Address - Fax:626-286-9177
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G454350Medicaid
CA00G454352Medicare PIN
CAA50041Medicare UPIN