Provider Demographics
NPI:1376793901
Name:CHU, GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3500 LOMITA BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5021
Practice Address - Country:US
Practice Address - Phone:310-257-0129
Practice Address - Fax:310-257-0130
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101606207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01377635OtherMEDICARE RAILROAD
CAP01377635OtherMEDICARE RAILROAD