Provider Demographics
NPI:1427133040
Name:MIKE C JOU DPM INC
Entity type:Organization
Organization Name:MIKE C JOU DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-820-0924
Mailing Address - Street 1:501 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4060
Mailing Address - Country:US
Mailing Address - Phone:626-820-0924
Mailing Address - Fax:626-820-0925
Practice Address - Street 1:501 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-4060
Practice Address - Country:US
Practice Address - Phone:626-820-0924
Practice Address - Fax:626-820-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4187261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5720332Medicaid
CAW20188OtherMEDICARE GROUP ID
CA000E41870Medicaid
CA5720332Medicaid
CAWE4187DMedicare PIN
CAE4187Medicare ID - Type Unspecified
CA000E41870Medicaid