Provider Demographics
NPI:1659314656
Name:CHU, KATHY CHILAN (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:CHILAN
Last Name:CHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3664
Mailing Address - Country:US
Mailing Address - Phone:912-350-7500
Mailing Address - Fax:912-350-7735
Practice Address - Street 1:4451 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3664
Practice Address - Country:US
Practice Address - Phone:912-350-7500
Practice Address - Fax:912-350-7735
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10063633OtherAMERIGROUP
GA349737OtherWELLCARE
GA110214427OtherRR MEDICARE
SCG34317Medicaid
GA000463064DMedicaid
GA349737OtherWELLCARE
SCG34317Medicaid