Healthcare Provider Details

I. General information

NPI: 1043318736
Provider Name (Legal Business Name): JAMIE WEN-WAM CHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 LAMME RD
MORAINE OH
45439-3215
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3598
US

V. Phone/Fax

Practice location:
  • Phone: 937-534-4632
  • Fax:
Mailing address:
  • Phone: 937-914-7054
  • Fax: 937-522-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number57463
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0025322
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101262946
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61139128
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.084797
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: