Provider Demographics
NPI:1750363388
Name:CHU, PAUL KWOK-MING (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KWOK-MING
Last Name:CHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 THEODORE FREMD AVE APT M2
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-6813
Mailing Address - Country:US
Mailing Address - Phone:914-967-0000
Mailing Address - Fax:914-967-0149
Practice Address - Street 1:130 THEODORE FREMD AVE APT M2
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-6813
Practice Address - Country:US
Practice Address - Phone:914-967-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051556-11223P0221X
CA502311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02662366Medicare ID - Type UnspecifiedDENIST- PEDODONTIST