Basic Information
| Provider Information | |||||||||
| NPI: | 1649450628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOU | ||||||||
| FirstName: | STELLA | ||||||||
| MiddleName: | YI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8789 S HIGHLAND DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840931600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019434999 | ||||||||
| FaxNumber: | 8019433876 | ||||||||
| Practice Location | |||||||||
| Address1: | 8789 S HIGHLAND DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840931600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019434999 | ||||||||
| FaxNumber: | 8019433876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 325931-1205 | UT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | D2940 | 01 | UT | MEDICAID LICENSE NUMBER | OTHER | 1649450628 | 05 | UT | MEDICAID |