Provider Demographics
NPI:1205842796
Name:CHU, DAVIS CO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:CO
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 1:1219 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1708
Mailing Address - Country:US
Mailing Address - Phone:702-633-5410
Mailing Address - Fax:702-320-1639
Practice Address - Street 1:1219 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1708
Practice Address - Country:US
Practice Address - Phone:702-633-5410
Practice Address - Fax:702-320-1639
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11087208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509946Medicaid