Provider Demographics
NPI:1568576445
Name:CHAU, MAGGIE SUE (DO)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:SUE
Last Name:CHAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 N BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1801
Mailing Address - Country:US
Mailing Address - Phone:408-923-8098
Mailing Address - Fax:408-923-8189
Practice Address - Street 1:54 N BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1801
Practice Address - Country:US
Practice Address - Phone:408-923-8098
Practice Address - Fax:408-923-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX64431Medicaid
020A64431Medicare ID - Type Unspecified
G12393Medicare UPIN