Provider Demographics
NPI:1669415857
Name:DU, CHI C (MD)
Entity type:Individual
Prefix:DR
First Name:CHI
Middle Name:C
Last Name:DU
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 1:1172 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3407
Mailing Address - Country:US
Mailing Address - Phone:530-673-3391
Mailing Address - Fax:530-673-3491
Practice Address - Street 1:1172 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3407
Practice Address - Country:US
Practice Address - Phone:530-673-3391
Practice Address - Fax:530-673-3491
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78856171W00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A788560Medicaid
CAH660008Medicare UPIN
CA00A788560Medicaid