Provider Demographics
NPI:1336465079
Name:CHU, HENNING (NP)
Entity Type:Individual
Prefix:MISS
First Name:HENNING
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:NP
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 18TH ST
Mailing Address - Street 2:#1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3822
Mailing Address - Country:US
Mailing Address - Phone:510-717-7175
Mailing Address - Fax:
Practice Address - Street 1:250 E 18TH ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1716
Practice Address - Country:US
Practice Address - Phone:510-735-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002719363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily