Healthcare Provider Details

I. General information

NPI: 1598917981
Provider Name (Legal Business Name): G SAMUEL S CHUA MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 SPRINGSTOWNE CENTER SUITE B
VALLEJO CA
94591-5566
US

IV. Provider business mailing address

96 SPRINGSTOWNE CENTER SUITE B
VALLEJO CA
94591-5566
US

V. Phone/Fax

Practice location:
  • Phone: 707-649-2228
  • Fax: 707-649-0120
Mailing address:
  • Phone: 707-649-2228
  • Fax: 707-649-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA49399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA41529
License Number StateCA

VIII. Authorized Official

Name: DR. GABRIEL SAMUEL SIY CHUA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-649-2228