Provider Demographics
NPI:1205976834
Name:CHU, JENNIFER PARK (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PARK
Last Name:CHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 86TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4125
Mailing Address - Country:US
Mailing Address - Phone:646-637-4057
Mailing Address - Fax:
Practice Address - Street 1:15600 NE 8TH ST STE A1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3917
Practice Address - Country:US
Practice Address - Phone:425-372-0036
Practice Address - Fax:425-643-2124
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600347661223G0001X
NY0518801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice