Basic Information
Provider Information
NPI: 1003803115
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOW
FirstName: TOM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25825 VERMONT AVE
Address2: KAISER PERMANENTE - DEPARTMENT OF ORTHOPEDICS
City: HARBOR CITY
State: CA
PostalCode: 907103518
CountryCode: US
TelephoneNumber: 3105172940
FaxNumber:  
Practice Location
Address1: 280 S MAIN ST
Address2: STE 200
City: ORANGE
State: CA
PostalCode: 928683852
CountryCode: US
TelephoneNumber: 7146344567
FaxNumber: 7146344569
Other Information
ProviderEnumerationDate: 10/04/2005
LastUpdateDate: 07/31/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA16324CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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