Healthcare Provider Details

I. General information

NPI: 1124018551
Provider Name (Legal Business Name): WILLIAM C CHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14148 FRANCISQUITO AVE
BALDWIN PARK CA
91706-6120
US

IV. Provider business mailing address

PO BOX 18989
ANAHEIM CA
92817-8989
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-7816
  • Fax: 213-621-7787
Mailing address:
  • Phone: 213-625-1861
  • Fax: 213-626-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA38858
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA38858
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA38858
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA38858
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA38858
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00A388580
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE SHIELD
# 2
Identifier00A388582
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE SHIELD PIN
# 3
Identifier300082097
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerRAILROAD MEDICARE
# 4
Identifier00A388582
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: