Basic Information
| Provider Information | |||||||||
| NPI: | 1023384781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOU | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | CHIEH-LI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMMUNITY MEDICAL ASSOCIATES INC | ||||||||
| Address2: | P.O. BOX 766351 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4420 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193643312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 49253 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2022-00180 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.