Healthcare Provider Details

I. General information

NPI: 1285401505
Provider Name (Legal Business Name): ROBERT CHU D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 GATEWAY DR STE 110
SAN MATEO CA
94404-2470
US

IV. Provider business mailing address

1810 GATEWAY DR STE 110
SAN MATEO CA
94404-2470
US

V. Phone/Fax

Practice location:
  • Phone: 650-345-2739
  • Fax: 650-345-2756
Mailing address:
  • Phone: 650-345-2739
  • Fax: 650-345-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number305229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: