Provider Demographics
NPI:1568033496
Name:CHU, BRYAN CHII-YEU
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CHII-YEU
Last Name:CHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 MATISSE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1449
Mailing Address - Country:US
Mailing Address - Phone:512-264-5927
Mailing Address - Fax:
Practice Address - Street 1:1505 E RIO GRANDE ST STE 120
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-7397
Practice Address - Country:US
Practice Address - Phone:361-235-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373631223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice