Provider Demographics
NPI:1497768725
Name:LAW, MALENA SHU CHU (MD)
Entity Type:Individual
Prefix:
First Name:MALENA
Middle Name:SHU CHU
Last Name:LAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 SANTA MONICA BLVD
Mailing Address - Street 2:210
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2023
Mailing Address - Country:US
Mailing Address - Phone:310-458-2381
Mailing Address - Fax:310-260-2963
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-458-2381
Practice Address - Fax:310-260-2963
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A740100Medicaid
CABO248ZMedicare PIN
CA00A740100Medicaid