Provider Demographics
NPI:1548384951
Name:CHU, DINH QUANG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DINH
Middle Name:QUANG
Last Name:CHU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 ENBORG LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2608
Mailing Address - Country:US
Mailing Address - Phone:408-826-9543
Mailing Address - Fax:
Practice Address - Street 1:2221 ENBORG LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2608
Practice Address - Country:US
Practice Address - Phone:408-826-9543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158341041C0700X
CALCS 158341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP299UMedicare PIN
CAGP299YMedicare PIN
CAGP299SMedicare PIN
CAGP299TMedicare PIN
CAGP299VMedicare PIN
CAGP299WMedicare PIN
ZZZ24373ZMedicare PIN
CAGP299RMedicare PIN
CAGP299PMedicare PIN
P70018Medicare UPIN
CAGP299XMedicare PIN
CAGP299QMedicare PIN
CAGP299ZMedicare PIN