Provider Demographics
NPI:1275658312
Name:CHU, BANG BA (MD)
Entity Type:Individual
Prefix:
First Name:BANG
Middle Name:BA
Last Name:CHU
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 1:9100 SOUTHWEST FWY STE 415
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1519
Mailing Address - Country:US
Mailing Address - Phone:713-777-1508
Mailing Address - Fax:713-777-1509
Practice Address - Street 1:9100 SOUTHWEST FWY STE 215
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1513
Practice Address - Country:US
Practice Address - Phone:713-777-1508
Practice Address - Fax:713-777-1509
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1361207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033847701Medicaid
C13127Medicare UPIN
TXTXB149318Medicare PIN