Provider Demographics
NPI:1689883910
Name:CHU, ALEXANDER (D D S)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 50TH ST
Mailing Address - Street 2:APT. 6B
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4347
Mailing Address - Country:US
Mailing Address - Phone:718-424-9766
Mailing Address - Fax:
Practice Address - Street 1:1221 WHITE PLAINS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4937
Practice Address - Country:US
Practice Address - Phone:718-792-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00946245Medicaid