Provider Demographics
NPI:1568680395
Name:FU, MAO-JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAO-JIN
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAO-JIN
Other - Middle Name:MORGAN
Other - Last Name:FU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 JEFFERSON AVE
Mailing Address - Street 2:# 6
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3522
Mailing Address - Country:US
Mailing Address - Phone:909-591-3855
Mailing Address - Fax:909-627-5056
Practice Address - Street 1:5450 JEFFERSON AVE
Practice Address - Street 2:# 6
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3522
Practice Address - Country:US
Practice Address - Phone:909-591-3855
Practice Address - Fax:909-627-5056
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 33783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337830Medicaid
CA00A337832Medicare PIN
CA00A337830Medicaid