Basic Information
| Provider Information | |||||||||
| NPI: | 1376539791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOU | ||||||||
| FirstName: | KELVIN | ||||||||
| MiddleName: | LIN-YU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4260 PLYMOUTH RD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481092700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347646831 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD11423 | RI | N | Other Service Providers | Specialist | 2084N0400X | 4301091116 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 29880 | 01 | RI | NEIGHBORHOOD HEALTH | OTHER | 050513332 | 01 | RI | UNITED HEALTHCARE | OTHER | 050513332 | 01 | RI | OXFORD | OTHER | 1376539791 | 01 | RI | NPI | OTHER | 411652 | 01 | RI | BLUE CHIP | OTHER | 29649 | 01 | RI | BLUECROSS BLUESHIELD RI | OTHER | 050513332 | 01 | RI | PHCS | OTHER | 050513332 | 01 | RI | TRICARE | OTHER | 3957622 | 01 | RI | AETNA | OTHER | 469157 | 01 | RI | TUFTS | OTHER | 7056733 | 05 | RI | MEDICAID | 2113376 | 01 | RI | MASSHEATLH | OTHER | AA29804 | 01 | RI | PILGRIM | OTHER |