Provider Demographics
NPI:1255365888
Name:CHAU, MARY (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28125 BRADLEY RD
Mailing Address - Street 2:SUITE 240B
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2248
Mailing Address - Country:US
Mailing Address - Phone:951-301-6366
Mailing Address - Fax:951-301-6366
Practice Address - Street 1:28125 BRADLEY RD
Practice Address - Street 2:SUITE 240B
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2248
Practice Address - Country:US
Practice Address - Phone:951-301-6366
Practice Address - Fax:951-301-6366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH51103Medicare UPIN