Provider Demographics
NPI:1285784371
Name:CHOU, JACQUELINE (LAC)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:CHOU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 CONVOY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3754
Mailing Address - Country:US
Mailing Address - Phone:858-560-8910
Mailing Address - Fax:858-560-8011
Practice Address - Street 1:3707 CONVOY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3754
Practice Address - Country:US
Practice Address - Phone:858-560-8910
Practice Address - Fax:858-560-8011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist