Provider Demographics
NPI:1578596920
Name:MAO-JIN FU, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MAO-JIN FU, A MEDICAL CORPORATION
Other - Org Name:MAO-JIN FU, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAO-JIN
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-591-3855
Mailing Address - Street 1:5450 JEFFERSON AVE STE 6
Mailing Address - Street 2:
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 STE 6
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337830Medicaid
CAA27251Medicare UPIN
ZZZ06556ZMedicare PIN