Provider Demographics
NPI:1841514866
Name:CHU, CHIN CHAN (MD)
Entity type:Individual
Prefix:
First Name:CHIN CHAN
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:5649 WYNNEWOOD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LAURYS STATION
Practice Address - State:PA
Practice Address - Zip Code:18059-1138
Practice Address - Country:US
Practice Address - Phone:610-261-1123
Practice Address - Fax:610-262-1739
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09302600207Q00000X
PAMD449255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA437418YUNMMedicare PIN
NJ303781ZPCNMedicare PIN
PA437418YEBKMedicare PIN