Provider Demographics
NPI:1942286364
Name:CHU, JOHN RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RANDALL
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 BURNETT PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4491
Mailing Address - Country:US
Mailing Address - Phone:530-848-0306
Mailing Address - Fax:
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:#330
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-733-5049
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86163207X00000X
AZ22920207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G861630Medicare ID - Type Unspecified
CAH52750Medicare UPIN