Provider Demographics
NPI:1083803860
Name:CHU, WENJIANG (MD)
Entity Type:Individual
Prefix:
First Name:WENJIANG
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2853
Mailing Address - Country:US
Mailing Address - Phone:310-923-8616
Mailing Address - Fax:310-396-3903
Practice Address - Street 1:2346 PEARL ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2853
Practice Address - Country:US
Practice Address - Phone:310-923-8616
Practice Address - Fax:310-396-3903
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90999207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology