Provider Demographics
NPI:1336223569
Name:CU, JOHNY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNY
Middle Name:A
Last Name:CU
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 1:1535 W MERCED AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-331-6411
Mailing Address - Fax:626-251-1560
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-331-6411
Practice Address - Fax:626-251-1560
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35970207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB205613OtherMEDICARE PTAN
CA00A359700Medicaid
A84841Medicare UPIN