Healthcare Provider Details

I. General information

NPI: 1851816276
Provider Name (Legal Business Name): SHAN C CHU MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N GARFIELD AVE STE 204
MONTEREY PARK CA
91754-1242
US

IV. Provider business mailing address

2275 ROANOKE RD
SAN MARINO CA
91108-2634
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-4393
  • Fax: 626-280-5379
Mailing address:
  • Phone: 626-280-4393
  • Fax: 626-280-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAN C CHU
Title or Position: OWNER
Credential: MD
Phone: 626-280-4393