Provider Demographics
NPI:1538102256
Name:CHUA, DERRICK OWEN CO (DMD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:OWEN CO
Last Name:CHUA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 MISSION ST.,
Mailing Address - Street 2:STE 12
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2400
Mailing Address - Country:US
Mailing Address - Phone:415-282-6810
Mailing Address - Fax:415-282-6816
Practice Address - Street 1:2489 MISSION ST
Practice Address - Street 2:STE 12
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2469
Practice Address - Country:US
Practice Address - Phone:415-282-6810
Practice Address - Fax:415-282-6816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52843OtherCA DENTIST LICENSE