Provider Demographics
NPI:1578991410
Name:FU, CHI D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:D
Last Name:FU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3651
Mailing Address - Country:US
Mailing Address - Phone:914-937-2810
Mailing Address - Fax:
Practice Address - Street 1:395 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3651
Practice Address - Country:US
Practice Address - Phone:914-937-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist