Healthcare Provider Details

I. General information

NPI: 1639259377
Provider Name (Legal Business Name): WILLIAM C. CHU, MD, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W ROUTE 66 RADIOLOGY DEPARTMENT
GLENDORA CA
91740-6207
US

IV. Provider business mailing address

PO BOX 18989
ANAHEIM CA
92817-8989
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-0231
  • Fax: 626-821-0406
Mailing address:
  • Phone: 626-821-1411
  • Fax: 626-821-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM C. CHU
Title or Position: PRESIDENT
Credential: MD
Phone: 626-335-0231