Provider Demographics
NPI:1104889724
Name:CHOU, SUSANNA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:ISABEL
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:374 E H ST
Mailing Address - Street 2:SUITE A, PMB-105
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7484
Mailing Address - Country:US
Mailing Address - Phone:619-425-5559
Mailing Address - Fax:619-425-5588
Practice Address - Street 1:340 4TH AVENUE
Practice Address - Street 2:SUITE 5A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-425-5559
Practice Address - Fax:619-425-5588
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2010-01-20
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Provider Licenses
StateLicense IDTaxonomies
CAA73158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731580Medicaid
CA00A731580Medicaid
H77976Medicare UPIN