Provider Demographics
NPI:1245322700
Name:CHU, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
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 1:4713 168TH ST SW STE 105
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-6813
Mailing Address - Country:US
Mailing Address - Phone:425-743-7000
Mailing Address - Fax:425-743-7373
Practice Address - Street 1:4713 168TH ST SW STE 105
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6813
Practice Address - Country:US
Practice Address - Phone:425-743-7000
Practice Address - Fax:425-743-7373
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031801208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1099688Medicaid
G115001023Medicare UPIN
F32998Medicare UPIN