Provider Demographics
NPI:1619950748
Name:CHU, FREDERICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13193 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-902-9111
Mailing Address - Fax:909-902-9199
Practice Address - Street 1:954 W FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-946-4222
Practice Address - Fax:909-946-8243
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY116550Medicaid
R15643Medicare UPIN
CAPSY116550Medicaid