Provider Demographics
NPI:1760482806
Name:CHU, THOMAS G (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:380
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4810
Mailing Address - Country:US
Mailing Address - Phone:213-483-8810
Mailing Address - Fax:213-481-1503
Practice Address - Street 1:1245 WILSHIRE BLVD STE 380
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4886
Practice Address - Country:US
Practice Address - Phone:213-483-8810
Practice Address - Fax:213-481-1503
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG68694207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74423ZMedicaid
CA1760482806OtherNPI
CA1134164023OtherGROUP NPI
CAW3452OtherPTAN
CA1760482806OtherNPI
CAZZZ74423ZMedicaid
F09031Medicare UPIN
CAWG6894AMedicare PIN