Provider Demographics
NPI:1265535686
Name:J. CHU-HSIANG CHI, M.D. INC.
Entity type:Organization
Organization Name:J. CHU-HSIANG CHI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHU-HSIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-715-2858
Mailing Address - Street 1:2255 W 230TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5208
Mailing Address - Country:US
Mailing Address - Phone:310-325-8437
Mailing Address - Fax:310-325-8688
Practice Address - Street 1:17777 CRENSHAW BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4120
Practice Address - Country:US
Practice Address - Phone:310-715-2858
Practice Address - Fax:310-325-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37803174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A37803Medicaid
CAE30281Medicare UPIN
CA00A37803Medicaid