Provider Demographics
NPI:1013975838
Name:CHU, EDMOND K (MD)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:K
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 W ORANGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3154
Mailing Address - Country:US
Mailing Address - Phone:714-952-0203
Mailing Address - Fax:714-952-1387
Practice Address - Street 1:3055 W ORANGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3154
Practice Address - Country:US
Practice Address - Phone:714-952-0203
Practice Address - Fax:714-952-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COG34289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006342890Medicaid
CA634289Medicare ID - Type Unspecified