Provider Demographics
NPI:1982823274
Name:CHU, WAI C (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAI
Middle Name:C
Last Name:CHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12302 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1835
Mailing Address - Country:US
Mailing Address - Phone:714-534-9292
Mailing Address - Fax:714-534-3631
Practice Address - Street 1:12302 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1835
Practice Address - Country:US
Practice Address - Phone:714-534-9292
Practice Address - Fax:714-534-3631
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29569261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental