Provider Demographics
NPI:1073576179
Name:HU-DUVAL, ANNIE CHINWEN (OD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:CHINWEN
Last Name:HU-DUVAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:CHINWEN
Other - Last Name:HU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1059 GAYLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3401
Mailing Address - Country:US
Mailing Address - Phone:310-208-3604
Mailing Address - Fax:310-208-6831
Practice Address - Street 1:1059 GAYLEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3401
Practice Address - Country:US
Practice Address - Phone:310-208-3604
Practice Address - Fax:310-208-6831
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11896T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22097OtherMEDICARE GROUP PTAN
CAGY195AOtherMEDICARE PTAN
CAW22097OtherMEDICARE GROUP PTAN