Provider Demographics
NPI:1407962343
Name:CHU, LAM S
Entity Type:Individual
Prefix:
First Name:LAM
Middle Name:S
Last Name:CHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LAM
Other - Middle Name:S
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642
Mailing Address - Country:US
Mailing Address - Phone:336-835-7500
Mailing Address - Fax:336-835-6809
Practice Address - Street 1:129 NORTH BRIDGE STREET
Practice Address - Street 2:129 NORTH BRIDGE STREET
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642
Practice Address - Country:US
Practice Address - Phone:336-835-7500
Practice Address - Fax:336-835-6809
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC66591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9007JMedicaid