Provider Demographics
NPI:1689007460
Name:BRIAN CHU, D.D.S., INC.
Entity Type:Organization
Organization Name:BRIAN CHU, D.D.S., INC.
Other - Org Name:VICTOR VALLEY KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-490-0790
Mailing Address - Street 1:14285 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4207
Mailing Address - Country:US
Mailing Address - Phone:760-388-5080
Mailing Address - Fax:760-388-5081
Practice Address - Street 1:14285 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4207
Practice Address - Country:US
Practice Address - Phone:760-388-5080
Practice Address - Fax:760-388-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51245122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty