Healthcare Provider Details

I. General information

NPI: 1003498346
Provider Name (Legal Business Name): ALLEN CHU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 PARAMOUNT BLVD
DOWNEY CA
90241-3303
US

IV. Provider business mailing address

5918 SUNHAWK DR
SANTA ROSA CA
95409-7304
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-7257
  • Fax:
Mailing address:
  • Phone: 707-486-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number109821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: