Provider Demographics
NPI:1396713814
Name:CHU, CECILIA (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 KATELLA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3108
Mailing Address - Country:US
Mailing Address - Phone:562-594-7555
Mailing Address - Fax:562-594-7553
Practice Address - Street 1:3771 KATELLA AVE
Practice Address - Street 2:#205
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3108
Practice Address - Country:US
Practice Address - Phone:562-594-7555
Practice Address - Fax:562-594-7553
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA743081093OtherTAX ID
CA00G795720Medicaid
CA743081093OtherTAX ID
CAG79572Medicare ID - Type Unspecified