Provider Demographics
NPI:1588757165
Name:CHOU, KOULIN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:KOULIN
Middle Name:LEE
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 EVESHAM ROAD, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-772-6050
Mailing Address - Fax:856-772-6404
Practice Address - Street 1:2301 EVESHAM ROAD, SUITE 103
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-772-6050
Practice Address - Fax:856-772-6404
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56331207N00000X
PAMD042661L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE87779Medicare UPIN
96028Medicare ID - Type Unspecified