Provider Demographics
NPI:1124018551
Name:CHU, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18989
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-8989
Mailing Address - Country:US
Mailing Address - Phone:213-625-1861
Mailing Address - Fax:213-626-2974
Practice Address - Street 1:14148 FRANCISQUITO AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-6120
Practice Address - Country:US
Practice Address - Phone:213-626-7816
Practice Address - Fax:213-621-7787
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA388582085B0100X, 2085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388580OtherBLUE SHIELD
CA00A388582OtherBLUE SHIELD PIN
CA300082097OtherRAILROAD MEDICARE
CA00A388582Medicaid
CA00A388582Medicaid
CA300082097OtherRAILROAD MEDICARE
CA00A388582Medicaid