Provider Demographics
NPI:1265476428
Name:CHUA, GABRIEL SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:SAMUEL
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2582
Mailing Address - Country:US
Mailing Address - Phone:707-427-4900
Mailing Address - Fax:707-551-3641
Practice Address - Street 1:100 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2582
Practice Address - Country:US
Practice Address - Phone:707-427-4900
Practice Address - Fax:707-551-3641
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49399208D00000X, 261Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A493992Medicaid
CA00A493990Medicare ID - Type Unspecified
CA00A493992Medicaid