Provider Demographics
NPI:1790996049
Name:DOMINIC Y. CHU, M.D., INC.
Entity Type:Organization
Organization Name:DOMINIC Y. CHU, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:YAU WAI
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-458-0281
Mailing Address - Street 1:850 S ATLANTIC BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4729
Mailing Address - Country:US
Mailing Address - Phone:626-458-0281
Mailing Address - Fax:626-458-0765
Practice Address - Street 1:850 S ATLANTIC BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4729
Practice Address - Country:US
Practice Address - Phone:626-458-0281
Practice Address - Fax:626-458-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50693208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506930Medicaid
CA00G506930Medicaid
CAG50693Medicare ID - Type Unspecified