Basic Information
Provider Information
NPI: 1407036239
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOU
FirstName: BENJAMIN
MiddleName: BOUN-MING
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 751 S BASCOM AVE
Address2: DIAGNOSTIC IMAGING
City: SAN JOSE
State: CA
PostalCode: 951282604
CountryCode: US
TelephoneNumber: 4088855000
FaxNumber:  
Practice Location
Address1: 751 S BASCOM AVE
Address2: DIAGNOSTIC IMAGING
City: SAN JOSE
State: CA
PostalCode: 951282604
CountryCode: US
TelephoneNumber: 4088855000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/08/2007
LastUpdateDate: 11/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XA93531CAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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