Provider Demographics
NPI:1619052628
Name:CHU, PAUL HUNG-JEN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HUNG-JEN
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 N HILL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1714
Mailing Address - Country:US
Mailing Address - Phone:213-617-0777
Mailing Address - Fax:213-613-0328
Practice Address - Street 1:945 N HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1714
Practice Address - Country:US
Practice Address - Phone:213-617-0777
Practice Address - Fax:213-613-0328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G787661Medicaid
CAG14460Medicare UPIN
CA00G787661Medicaid