Provider Demographics
NPI:1407337876
Name:CHU, TAMMY ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ELIZABETH
Last Name:CHU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SOUTH DR STE 115
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4211
Mailing Address - Country:US
Mailing Address - Phone:408-369-5620
Mailing Address - Fax:408-558-7919
Practice Address - Street 1:612 W DUARTE RD STE 205
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9229
Practice Address - Country:US
Practice Address - Phone:626-446-8809
Practice Address - Fax:626-446-8268
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55857207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty