Provider Demographics
NPI:1871673616
Name:CHU, LISA LEUNG (DPM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LEUNG
Last Name:CHU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:Y
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:#106
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:310-323-2887
Mailing Address - Fax:
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:#106
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-323-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4549213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00413Medicare ID - Type UnspecifiedMEDICARE
CAW17871Medicare PIN