Provider Demographics
NPI:1447282876
Name:CHOW, THICK GW (MD)
Entity type:Individual
Prefix:
First Name:THICK
Middle Name:GW
Last Name:CHOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SOUTH VERMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1522
Mailing Address - Country:US
Mailing Address - Phone:213-385-0029
Mailing Address - Fax:213-385-5619
Practice Address - Street 1:817 SOUTH VERMONT AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1522
Practice Address - Country:US
Practice Address - Phone:213-385-0029
Practice Address - Fax:213-385-5619
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A291130Medicaid
A25663Medicare UPIN
CA00A291130Medicaid