Healthcare Provider Details

I. General information

NPI: 1649561168
Provider Name (Legal Business Name): ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 10TH ST SE
PUYALLUP WA
98374-2188
US

IV. Provider business mailing address

2728 E MAIN AVE STE A
PUYALLUP WA
98372-3198
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-6656
  • Fax: 253-840-6787
Mailing address:
  • Phone: 253-848-6656
  • Fax: 253-840-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 30106729
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 60106729
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 60106729
License Number StateWA

VIII. Authorized Official

Name: CHARLES R CHU
Title or Position: PHYSICIAN/ OWNER
Credential: DPM
Phone: 425-449-2471