Healthcare Provider Details

I. General information

NPI: 1366481822
Provider Name (Legal Business Name): VINCENT K CHU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3481 FOXCROFT DR
LEWIS CENTER OH
43035-9341
US

IV. Provider business mailing address

3481 FOXCROFT DR
LEWIS CENTER OH
43035-9341
US

V. Phone/Fax

Practice location:
  • Phone: 614-975-3965
  • Fax:
Mailing address:
  • Phone: 614-975-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number34.004211
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: