Provider Demographics
NPI:1780777615
Name:CHU, DIANA OCHOA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:OCHOA
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 1:808 S MICHIGAN AVE APT 5201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2660
Mailing Address - Country:US
Mailing Address - Phone:312-402-9796
Mailing Address - Fax:
Practice Address - Street 1:407 130TH AVE S
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359
Practice Address - Country:US
Practice Address - Phone:320-532-4005
Practice Address - Fax:320-532-4898
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN643322084P0800X, 2084P0804X
IL0360829232084P0804X
WI205-3202084P0804X
MNPT154022084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082923Medicaid