Provider Demographics
NPI:1760856033
Name:CHU, CONNIE
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S SIERRA VISTA AVE
Mailing Address - Street 2:APT D
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4545
Mailing Address - Country:US
Mailing Address - Phone:626-863-6243
Mailing Address - Fax:
Practice Address - Street 1:1540 ALCAZAR ST
Practice Address - Street 2:CHP-133
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0080
Practice Address - Country:US
Practice Address - Phone:323-442-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVOT-2269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program