Provider Demographics
NPI:1811059371
Name:CHU, DOMINIC YAU WAI (MD)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:YAU WAI
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YAU WAI
Other - Middle Name:
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:850 S ATLANTIC BLVD
Mailing Address - Street 2:#300
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-458-0281
Mailing Address - Fax:626-458-0765
Practice Address - Street 1:850 S ATLANTIC BLVD
Practice Address - Street 2:#300
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-458-0281
Practice Address - Fax:626-458-0765
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50693208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506930Medicaid
E71880Medicare UPIN
CAG50693Medicare ID - Type Unspecified