Healthcare Provider Details

I. General information

NPI: 1265476428
Provider Name (Legal Business Name): GABRIEL SAMUEL CHUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR STE 200
VALLEJO CA
94589-2582
US

IV. Provider business mailing address

100 HOSPITAL DR STE 200
VALLEJO CA
94589-2582
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-4900
  • Fax: 707-551-3641
Mailing address:
  • Phone: 707-427-4900
  • Fax: 707-551-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA49399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA49399
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA49399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: