Healthcare Provider Details

I. General information

NPI: 1740454735
Provider Name (Legal Business Name): ANNIE SHU & MICHAEL CHU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W DUARTE RD STE 170
ARCADIA CA
91007-7610
US

IV. Provider business mailing address

632 W DUARTE RD STE 170
ARCADIA CA
91007-7610
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-1278
  • Fax:
Mailing address:
  • Phone: 626-445-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNIE SHU
Title or Position: PARTNER
Credential: M.D.
Phone: 626-823-8928