Provider Demographics
NPI:1346235959
Name:CHU, CHARLES R (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:CHU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 E MAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3198
Mailing Address - Country:US
Mailing Address - Phone:253-841-2006
Mailing Address - Fax:253-840-6691
Practice Address - Street 1:2728 E MAIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3198
Practice Address - Country:US
Practice Address - Phone:253-841-2006
Practice Address - Fax:253-840-6691
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO00000277213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1694306Medicaid
WA0155724OtherLABOR AND INDUSTRIES
WACJ4574OtherRAIL ROAD MEDICARE
WA7109770Medicaid
WACH3153OtherREGENCE
WAGAB25234Medicare PIN
WAGAB25239Medicare PIN
WAAB25243Medicare PIN
WACH3153OtherREGENCE
WAG8906838Medicare PIN
WAT01558Medicare UPIN
WAG8906843Medicare PIN
WA7109770Medicaid