Provider Demographics
NPI:1104803048
Name:CHOW, THEODORE (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:CHOW
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 LESTER CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6510
Mailing Address - Country:US
Mailing Address - Phone:408-240-5960
Mailing Address - Fax:650-969-8679
Practice Address - Street 1:515 SOUTH DR
Practice Address - Street 2:SUITE # 23
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4204
Practice Address - Country:US
Practice Address - Phone:650-961-7021
Practice Address - Fax:650-969-8679
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53436207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18630Medicare UPIN