Healthcare Provider Details

I. General information

NPI: 1952509440
Provider Name (Legal Business Name): ANA CHU, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25211 PASEO DE ALICIA SUITE 100
LAGUNA HILLS CA
92653-4614
US

IV. Provider business mailing address

3535 E COAST HWY SUITE 54
CORONA DEL MAR CA
92625-2404
US

V. Phone/Fax

Practice location:
  • Phone: 949-900-3480
  • Fax: 949-900-3484
Mailing address:
  • Phone: 949-244-2628
  • Fax: 949-706-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG56006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG56006
License Number StateCA

VIII. Authorized Official

Name: DR. ANA NMN CHU
Title or Position: PRESIDENT
Credential: MD
Phone: 949-244-2628