Provider Demographics
NPI:1639487697
Name:CECILIA CHU, M.D., INC.
Entity Type:Organization
Organization Name:CECILIA CHU, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-594-7555
Mailing Address - Street 1:3771 KATELLA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3108
Mailing Address - Country:US
Mailing Address - Phone:562-594-7555
Mailing Address - Fax:562-594-7553
Practice Address - Street 1:3771 KATELLA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3108
Practice Address - Country:US
Practice Address - Phone:562-594-7555
Practice Address - Fax:562-594-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G795720Medicaid
CA00G795720Medicaid
CAG79572Medicare PIN